Depot Repair Form

"*" indicates required fields

Your Name*

Facility Name*

Phone*

Location of Equipment*

Street Address Address Line 2 City State ZIP Code

Is This For Repair or Estimate?*

Flat Rate Repair

Warranty Repair

Repair

Estimate

Detailed Description of Issue(s)*

What accessories are you including, I.e., Battery, Cables, etc.*

Is the repair under warranty?*

Yes

Item Type*

Manufacturer*

Model #*

Serial #*

Do you have more than 1 item for repair?*

Yes

Item Type

Manufacturer

Model #

Serial #

Billing Address*

Street Address Address Line 2 City State ZIP Code

Ship to Address (No PO Boxes) if address is different than bill to

Street Address Address Line 2 City State ZIP Code

RMA#

Please send items to:

Terrain Biomedical, Inc.
1643 Barclay Blvd.
Buffalo Grove, IL 60089
Office: (773) 697-8400
Attn: Service Dept.

Important Shipping Instructions:Please ensure that the equipment is thoroughly cleaned and decontaminated before packaging. If the unit is received without proper decontamination, a $50.00 decontamination fee will be applied. For shipping, use a corrugated cardboard box with a minimum of 4 inches of padding around the entire unit to prevent damage and ensure there are NO voids. Bubble wrap and packing peanuts are acceptable form of padding material. Please note that Terrain Biomedical is not responsible for any damage incurred during shipping.

Abandon product. If you have not claimed your product and paid all charges due within sixty (60) days after being notified by Terrain Biomedical that your product is available to be returned to you, Terrain Biomedical will consider your product abandoned. Terrin Biomedical may dispose of your product in accordance with applicable provisions of law, and specifically, may sell your product without any liability. Terrain Biomedical reserves its statutory and any other lawful liens for unpaid charges

Questions? Call

(773) 697-8400

Depot Repair Form

Need help? We're waiting for your call at (773) 697-8400

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