Service Request Form

Customer Information
Request Type*
- Request for Quote
- Request for Service
Returning Customer?
- Returning Customer?
Company Name*
Company Contact*
Email*
Phone*
Shipping/Billing
Shipping Address*
Street Address Address Line 2 City Province Postal Code
Billing Address: Same as shipping?*
- Yes
- No
Billing Address*
Street Address Address Line 2 City Province Postal Code
Equipment Service Request

List

I don't have a RAM#	RAM#	Manufacturer	Model	Serial #	Location	Customer Site (Room #)	Service Type	Other Service Type	Calibration Interval	Other Calibration Interval	Service Comments

Service Approval
Signature (Full Name)*
Date**
MM slash DD slash YYYY
Certify**
- Please ensure decontamination from bio-hazardous and radioactive materials. I certify that the equipment identified in this form are safe for handling by the employees of Raeyco Lab Equipment Systems Management Ltd.
  For ISO calibration services, I confirm that I have read and understand the conformance statement as stated below.
CAPTCHA

18016

Please note that any inaccuracies in the way this form is filled out may cause delays in the calibration cycle.

We cannot be held responsible for any damages that may occur during the shipping but we will always ensure your equipment is packaged well when it leaves our location. If you do see any damages upon receiving your equipment back from us, please notify us immediately.

For any ways we can improve our services or this form, please let us know.

[NOTE] ISO Calibration Statements of Pass or Fail Conformance: Uncertainty of measurement will be taken into account when determining compliance with specification, as per ILAC-G8:03/2009. The status of compliance with the acceptance criteria will be reported as: – PASS: Compliance with specification – FAIL: Not compliance with specification – FAIL2 : The measured value is not within the acceptance limits, however, a portion of the expanded uncertainty of measurement at 95% is within the specified tolerance. – PASS2 : The measured value is within acceptance limits. However, a portion of the expanded uncertainty of measurement at 95% exceeds the specified tolerance.

Service Request Form

Customer Information

Shipping/Billing

Equipment Service Request

Service Approval