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Repair Request Form
Subject:
*
Facility Name:
*
Contact Name:
*
Email:
*
Account #:
Phone #:
*
PO #:
Billing Address:
Shipping Address:
Return Shipment Options:
FedEx Saver
FedEx 2 Day
FedEx Priority Overnight
My Account
Device Information Format:
Brand/Model, Qty, Serial # or Lot #, Problem Description, Requested Return By (Date)
Shipping Tips:
1. Package device securely in a case.
2. Make sure the blades are retracted & secured.
3. Please place contact information inside of the package!
Ship Repairs to:
Mastel Surgical
ATTN: Repairs
1550 Samco Rd.
Rapid City, SD 57702
Send a copy to myself
I consent to my submitted data being collected and stored
*
Submit
Repair Request Form
Subject:
*
Facility Name:
*
Contact Name:
*
Email:
*
Account #:
Phone #:
*
PO #:
Billing Address:
Shipping Address:
Return Shipment Options:
FedEx Saver
FedEx 2 Day
FedEx Priority Overnight
My Account
Device Information Format:
Brand/Model, Qty, Serial # or Lot #, Problem Description, Requested Return By (Date)
Shipping Tips:
1. Package device securely in a case.
2. Make sure the blades are retracted & secured.
3. Please place contact information inside of the package!
Ship Repairs to:
Mastel Surgical
ATTN: Repairs
1550 Samco Rd.
Rapid City, SD 57702
Send a copy to myself
I consent to my submitted data being collected and stored
*
Submit
Not ready to fill this out yet? Download our Repair Request Form as a Fillable PDF.
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