NZ Equipment Repair Request Form

Request Date*

Date

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

ReproScan Model*

ReproScan Serial Number (if applicable)

Upload photos of the equipment that needs repair (if required/possible)

Date of purchase (approx.)

Date

Has the equipment listed above been repaired for the same issue previously?*

YesNo

Was the issue caused by accidental damage like water spill, equipment was dropped?*

YesNo

Description of problem and any notes or concerns*

IMPORTANT!

Please note the following -

Please clean eqipment prior to sending otherwise up to a $150 cleaning fee will be added.
Package equipment carefully and ensure you include your name, phone number return postal address
Keep a copy of your postage tracking information
POSTAL ADDRESS for sending repairs -
PAGE BIOMEDICAL NZ LTD
86 Castles Road - Oropi (Tauranga) 3173
Ph: 0204 039 9352
Please allow 7-10 days for your repair to be completed. If it will be longer than this - we will contact you. This would only be the case if special parts need to be ordered for your repair. We carry most common parts for all units in stock.
Repairs require payment prior to returning. We have various payment methods available.

I have read the above points and acknowledge them*

Yes

Equipment Repair Request Form