Pipette Service Request Form

Please fill in the fields below as completely as possible.

Note: You can add rows to this form by entering a numeric value in the field below the line items and submitting the form. It will redraw with any previously entered data and have the additional rows you specified.

Fields with red labels are required.
Your name
Your e-mail
please enter a fully qualified email address, complete with the domain, e.g. someuser@mbl.edu
Your telephone
Vendor name
Vendor Phone/Web Site
Cost Center
Other Cost Center:
Carbon Copy
please enter a fully qualified email address, complete with the domain, e.g. someuser@mbl.edu
 Send a copy of this email to:
Line Items
Serial number
Pipette Model Name and Volume
Type
Malfunction Description
Unit Price
Other Cost Ctr,
if split order
To add rows, enter how many more you'd like here: and then click the "Send Order" button below...

Additional comments:

Notice
  • Pipettes cannot be serviced unless you have a purchase order in hand.

Please e-mail orders at orders@mbl.edu or call x7282 if you have any problems with this form.