Scientific Refrigeration, Incubator & Laboratory
Equipment Specialist
Copyright © 2000 - 2023 Price’s Scientific Services, Inc.
Service Request Form
(If this is an emergency call, please contact us at (919) 493-1223)
Please fill out all the appropriate fields to request service.
Company Name
*
Customer Name
*
Phone Number
*
Alt. Phone Number
Fax Number
Email
*
Billing Address
Physical Address
Building Number/Room Number
Model #
*
Serial #
*
Problem
*
Payment Option
Purchase Order
Credit Card
Purchase Order #
Alt. Contact Name
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Scientific Refrigeration,
Incubator & Laboratory
Equipment Specialist
Copyright © 2000 - 2023 Price’s Scientific Services, Inc.
Service Request Form
(If this is an emergency call, please contact us at (919) 493-1223)
Please fill out all the appropriate fields to request service.
Company Name
*
Customer Name
*
Phone Number
*
Alt. Phone Number
Fax Number
Email
*
Billing Address
Physical Address
Building Number/Room Number
Model #
Serial #
Problem
Payment Option
Purchase Order
Credit Card
Purchase Order #
Alt. Contact Name
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