Service Center Request

Shipping Address: 3251 Olcott Street, Santa Clara, CA 95054, USA

Phone: +1-408-962-9990

Fax: +1-408-734-1799

Email: [email protected]

This form is for repair, calibration and any other services for your equipment.

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1. Company Information

Company Name

Street Address 1

Street Address 2

P.O. Box

P.O. Box 2

Country

State

City

Zip Code

Contact Name*

Phone/ Mobile*

Email*

Fax

2. Shipping Information

Same as above

Company Name

Street Address 1

Street Address 2

P.O. Box

Country

State

City

Zip Code

Contact Name*

Phone/ Mobile*

Email*

Fax

3. Repair Budget Information

To avoid delay. I hereby authorised Vivax-Metrotech to proceed with my equipment(s) repair if cost does not exceed below budget:

USD $200.00 USD $300.00 USD $400.00 USD $500.00

I require estimation regardless of price

Return Freight Options:

Ground 3 Days 2 Days Overnight

4. Payment Information

Invoice to my account

PO or Reference number

Credit Card Note: To provide upon arrival

5. Product Information

Category Name	Product Name	S/N

Can't find your products? Email: [email protected] or Call: +1-408-734-1799

Other Products/Accessories:

Product Issues:

Note: Upon completetion, please print this form and place a copy in the box with your equipment.
Ship to 3251 Olcott St Santa Clara, CA 95054

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