Repair Order

Fill out the form below and print this page. Cut out the mail label, affix it to the packaging, and include the completed form with the items to be repaired. When packaging the items please secure them well enough to make it through the US mail.

Handpiece Repair Order

Box 313 Altamont, IL 62411 866-349-3070

Office Required

Contact

Address Line 1

Address Line 2

City

State

Zip

Phone Number Required

Email Address

Item 1

Serial #

Call with estimate or proceed with repair? Proceed with repair Call with estimate

Problem

Item 2

Serial #

Call with estimate or proceed with repair? Proceed with repair Call with estimate

Problem

Item 3

Serial #

Call with estimate or proceed with repair? Proceed with repair Call with estimate

Problem