Repair Request Form


Repair Department

Narishige International USA, Inc.
415 Bayview Avenue, Amityville, NY 11701


Please complete "Repair Request Form" below and fax or email it to us. Please be sure to enclose copy of the completed form in the package when you send the equipment to us.

Form for FAX is here.


Customer Information (Shipping Address)

* Required Fields

* Name:
* University/Company:
* Department:
* Address1:
Address2:
* City:
* State:
* Postal Code:
* Country:
* Phone:
Fax:
* E-mail:
* E-mail (Confirm):
Tax Exempt Number:

If different from above address:

Shipping Address:

Would you like us to contact you before you send the equipment?   

/

Equipment to be repaired:

Qty: Product No: Serial No:
Qty: Product No: Serial No:
Qty: Product No: Serial No:
Qty: Product No: Serial No:
Qty: Product No: Serial No:
Qty: Product No: Serial No:

Comments:

Estimated Time of Arrival: / / (mm/dd/yyyy)

**DO NOT use Federal Express to send unit to Narishige from outside U.S.A. **

Please complete and print out this form before sending. Ensure to enclose this in the package with equipment, so we know who it is from when we receive it.