Repair Request Form

Please fill out the following for completely so that we may better serve you:

Email:
First Name:
Last Name:
Describe Your Facility:
Company Name:
Address 01:
Address 02:
City:
State:
Zip:
Country:
Phone Number:
Best Time to Reach You:
Mornings Afternoons Anytime
Equipment Type:
Manufacturer:
Model Number:
Please describe the symptoms/diagnosis:
Special instructions:



We will contact you within 1 business day with a repair quote, timeframe and instructions on how to proceed with your repair.




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Inex Surgical, Inc. | 5731 West Howard Street | Niles, Illinois (IL) 60714 | USA | tel (847) 674-2595 | fax (847) 674-2820 | REPAIR REQUESTarrow

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