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BIPOLAR_ MONOPOLAR FORCEPS REPAI

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					BIPOLAR, MONOPOLAR FORCEPS REPAIR
This form must accompany all Bipolar, Monopolar Forcep shipments
Send Bipolar, Monopolar Forceps Repairs To: Simnar Surgical, Inc. 577 West 1350 South, Suite B Woods Cross, UT 84010 Phone: 1-801-294-0977 Fax: 1-801-294-0978 Corporate & Billing Address Simnar Surgical, Inc. 1781 South 400 East Kaysville, Utah 84037 Phone: 801-294-0977 Fax: 1-801-294-0978

A Trusted Name in Surgical Instrument Repair Services since 1985

Customer/Facility Customer Name: Customer Return Shipping Address:

Phone Fax E-Mail Please Quote Pre-Approved Customer’s Signature By Fax

Ext

By E-Mail

Return Shipping: Fed Ex overnight shipping included in flat rate repairs.

PLEASE CHECK THE PROPER BOX FOR ITEM(S) BEING SENT IN

Make/Model Description of problem

Serial Number

Make/Model Description of problem:

Serial Number

Please fax a copy of this completed form and fax to 1-801-294-0978. Include this with your shipment.

Please make sure that all instruments are decontaminated and disinfected before shipping to Simnar Surgical, Inc.

Thank you for your business!

Thank you for your business!
Visit Simnar.Com for great savings on other O.R. Repairs!
Bipolar, Monopolar Forceps Repair Customer Order Form.doc