GLH Request Service Form

Good Liquid Handling Request for Service

By providing details helps us better serve you
Name*

First NameLast Name
Title/Role*
Company*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
What type of Service do you think you need?*

Calibration (Precision/Accuracy)UpgradeInstall QualificationOperational QualificationVolume VerificationPreventative Maintenance CheckRoutine Service CallEmergency CallOptimization of Liquid ClassMethod DevelopmentValidationCompliance checkProcess reviewQuality Assurance checkQuality Control TestingPart ReplacementsOther
Is your equipment needing repair out of service contract?*

YesNo
Is this an immediate need?*

YesNo
What do you prefer?*

Bundled service contract with training, development, and do it yourself calibration kits ( max savings)Multi yr service/repair contract1 yr service/repair contract with quick scheduling and 24 hr supportHourly time, materials, and travel only
Which Liquid Classes do you work with*

Thick or highly viscous solutionsModerately viscous (DMSO)Thin or running solutions (Alcohols or Acetyl Nitrile)Salt or buffer solutionsAqueous solutionsBubbly or foamy solutions (Blood, Soap or surfactants)AerosolsVolatile or Easily EvaporatingClot forming (Blood, particles)Hazardous or harsh acids (TFA)Sticky solutionsOrganic solutionsOther
Type of Lab*

ClinicalForensicsResearchChemistryDrug DiscoveryTesting LabOther
My Lab is*

FDA RegulatedCLIA LaboratoryMust Follow Lab Compliance 21 CFR Part 11ISO CertifiedGMP CertifiedGLP CertifiedMust be NIST TraceableOther
Liquids Used

BuffersSerumsDMSOOrganic Solvents(DMF,DCM,DCE)Acids(TFA)AqueousOilsMagnetic BeadsDNA ExtractsRNA ExtractsAlcoholsAcetyl NitrileBlood SerumOther
Dispensing

Performing Accurate DispensingPerforming Multi-DispensingPerforming Bulk DispensingFor Sample PrepsFor Plate ReformatingBiomarkersScreening AssaysTissueSolid beadsClot sensitive samplesOther
Automated Steps Performed

IncubatingThermocyclingMixingChillingHeatingLiddingStackingPlate shuttlingSpinningFilteringExtractingEvaporating or HoodingPick and PlacingWashingOther
Tips used*

Primarily DisposableMainly Fixed tipsboth depends
Labware used*
Volumes to verify*
List the volume(s) you need verified on each piece of equipment

Which equipment do you need to calibrate or service?*

Rows	nl	ul	ml	Fixed	Disposable	Gripper Arm	Single Channel	Span4	Span8	Span16	Span24	96 Channel	384 Channel	Not Used
Agilent Vprep
Agilent Bravo
Beckman FX
Beckman NX
Beckman Biomek 2000
Beckman Biomek 3000
Beckman Biomek 4000
Beckman Multimek
BioDot
Dynamic Devices Lynx LM700
Dynamic Devices Lynx LM900
Dynamic Devices Lynx LM1200
Dynamic Devices Lynx LM1800
Dynex DS2
Dynex DSX
EDC BioSystem
Eppendorf EP Motion
Gilson
Hamilton Nimbus
Hamilton Starlet
Hamilton Star
Integra
LabCyte Echo
Leap
LetsGo LGR BioRaptr 2
LetsGo LGR LiquiP!CK
LetsGo LGR Precision Drop II
Perkin Elmer Miniprep
Perkin Elmer Janus
Perkin Elmer Packard Multiprobe
Perkin Elmer Caliper Sciclone
Opentron
Stojadinovic Smartbot
Tecan Fluent
Tecan Freedom Evo
Tecan Evo 75
Tecan MCA
Tecan Miniprep
Tecan Fliper
Tecan TeMo
Tecan Genesis Freedom
Tecan Genesis RSP
TomTec
TTP Labtech Mosquito
Other not listed

Which readers are used in your Volume Verification?*

Rows	Absorbance	Fluorescence	UV	other	Not Used
Beckman AD340
Beckman LD400
Beckman DTX 880
Biotek uQuant
Biotek Elx800
Biotek Elx808
Biotek Powerwave
Biotek Synergy
BMG Floustar
BMG Spectrostar
BMG Clariostar
BMG Perastar
Byonoy
Molecular Dynamics Vmax
Molecular Devices Emax
Molecular Devices MDC
Molecular Devices Thermomax
Molecular Devices Spectramax
Perkin Elmer Victor
Perkin Elmer Envision
Perkin Elmer Ensight
Prometgo Glomax
Tecan Sunrise
Tecan Spectra
Tecan Ultra
Tecan Infinite
Tecan NanoQuant
Other

Other Equipment
Mention details of any equipment which you are using that is not listed above
Preferred method for Volume Verification and Delivery Calibration*

GravimetericAbsorbance Single DyeMVS Dual DyeFluorescenceUVOther
Deck Size

6075100150200Not sure
Syringe sizes

1ml (100ul)2.5 ml (250ul)500ul5mlother
Serial Number
Version of Robot(s) Software
Tubing

Low VolumeStandardHigh Volume
Check all that apply

CarouselIncubatorVacuum ManifoldWasher(s)Stacker
Problem*

Liquid Level SensingPositional accuracyNot HomingError ScreenVolume delivery is offDiluter issuePeristaltic Pump issuePower issueDrive Belts issueGripper or Roma issueWasher issueReader IssueIncubator issueStacker issueVacuum Manifold issuePrecision is offAccuracy is offOther
Describe the Problem*
Best time for Maintenance*

Early WeekMid WeekEnd of WeekWeekendAfternoonEarly morningAfter hours 5pmTime zone is PSTTimezone is ESTTimezone is CSTOther Timezone
Number of Total Robot Arms
Enter the message as it's shown*
Should be Empty:

Good Liquid Handling Request for Service