Please complete the form below. Print it and fax it to 631-841-0066. Please be sure to enclose the completed form in the package when you send the equipment to us.
**DO NOT use Federal Express to send unit to Narishige from outside U.S.A.**
DATE: / / (mm/dd/yyyy)
Repair Department
Narishige International USA, Inc.
415 Bayview Avenue, Amityville, NY 11701
Name:
Department:
University or Company:
Street:
City: State: Zip:
Country: E-mail:
Phone: ext: Fax:
Shipping Address (if different from above address):
Would you like us to contact you before you send the equipment? /
Model Number: 1. 2. 3. 4.
Serial Number: 1. 2. 3. 4.
Description of Problem:
Estimated Time of Arrival: / / (mm/dd/yyyy)