Service Request Form Completed By:

Company.

Address 1.

Address 2.

City.
Province.
Postal Code.
Contact.
E-mail.
Website.
Phone number.
Fax number.
Exl.

Product information.



Model.
Serial #
How many years owned? And date of manufacture
Date of Last Repair/Service.
Reason for Last Service on Unit

Accessories:
Applicator
Leads
Power Cord
Power Supply


Reason:
Unit inoperative, no power
Error code appears
Weak or no output
Timer
Display
Buttons
Cables
Battery Low
Alarms
Other




Problem occurs:

All the time
After several treatments
Only occasionally
At first power up (cold)
Requesting the following:

Repair and return
Request Estimate
Calibration only
Ignore cosmetic flaws


Details / Comments / Descriprion of Problem(s):


Preferred Payment Method

COD
Cheque upon completion
Email money transfer
VISA/Mastercard/AMEX


Company, email, and contact fields required to submit ticket.

BES

BES will provide a free estimate of repairs. Non-repaired units can be shipped back to you with no service charge, shipping and handling charges will apply.

BES

Please Ship your system via FedEx, Purolator, or UPS; as using postal service can result in the delay or loss of your system.