Repair Request Form

Repair
Request

Please fill in all the fields of this form. One of our technical support specialists will reply as soon as possible. Your repair request has to be approved by our specialists. After being approved, please ship your equipment to Dispomed Ltd 745 Nazaire-Laurin Joliette QC J6E 0L6, with attention to the Repair department.

Company Name

First Name

Last Name

Phone

Address

Province

Product description

Serial number

Accessories included

Description of the problem

Date

Signature

Agreement

Please check to agree. All shipping charges are the customer's responsibility (these are not covered by warranties). All items with an evaluation equal to or less than $500 (estimation fee included) will automatically be processed to be repaired. All repairs that haven’t been approved or declined within 2 weeks of the reception of the repair quote will be automatically returned to the customer. Taxes are not included in the quotation.

Repair
Request

Company

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Dispomed ltd.