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    Repair and Calibration Request Form (Blank) - 1-1

    Uploaded by

    Dedi Sudrajat
    This document is a repair/calibration form used by PT Merck Chemicals and Life Sciences to request instrument repairs or calibrations. It collects customer and instrument details like the customer name, address, contact information, instrument type, serial number, last calibration date, parts or accessories needing service, and notes on requested services. Customers must fill out the form completely and email it to service_admin@merckgroup.com to initiate a repair or calibration request.

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    Repair and Calibration Request Form (Blank) - 1-1

    Uploaded by

    Dedi Sudrajat
    209 views1 page
    This document is a repair/calibration form used by PT Merck Chemicals and Life Sciences to request instrument repairs or calibrations. It collects customer and instrument details like the customer name, address, contact information, instrument type, serial number, last calibration date, parts or accessories needing service, and notes on requested services. Customers must fill out the form completely and email it to service_admin@merckgroup.com to initiate a repair or calibration request.

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    Repair and Calibration Request Form (Blank)-1-1

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    This document is a repair/calibration form used by PT Merck Chemicals and Life Sciences to request instrument repairs or calibrations. It collects customer and instrument details like the customer name, address, contact information, instrument type, serial number, last calibration date, parts or accessories needing service, and notes on requested services. Customers must fill out the form completely and email it to service_admin@merckgroup.com to initiate a repair or calibration request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    209 views1 page

    Repair and Calibration Request Form (Blank) - 1-1

    Uploaded by

    Dedi Sudrajat
    This document is a repair/calibration form used by PT Merck Chemicals and Life Sciences to request instrument repairs or calibrations. It collects customer and instrument details like the customer name, address, contact information, instrument type, serial number, last calibration date, parts or accessories needing service, and notes on requested services. Customers must fill out the form completely and email it to service_admin@merckgroup.com to initiate a repair or calibration request.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    PT Merck Chemicals and Life Sciences

    Form Number
    Repair / Calibration Form

    Please fill up this form completely for instrument repair/calibration request and E-mail to
    service_admin@merckgroup.com

    * mandatory field must be filled


    Customer data *
    (for direct user)

    Company : ……………………………………………………………………………………………………………………

    Instrument Shiping Address : ……………………………………………………………………………………………………………………

    Contact Person : ……………………………………………………………………………………………………………………

    Company Phone : ……………………………………………………………………………………………………………………

    Mobile Phone : ……………………………………………………………………………………………………………………

    Email : ……………………………………………………………………………………………………………………

    Supplier data*
    (for third party)

    Company : ……………………………………………………………………………………………………………………

    Instrument Shiping Address : ……………………………………………………………………………………………………………………

    Contact Person : ……………………………………………………………………………………………………………………

    Company Phone : ……………………………………………………………………………………………………………………

    Mobile Phone : ……………………………………………………………………………………………………………………

    Email : ……………………………………………………………………………………………………………………

    Instrument Details *
    Instrument type : ……………………………………………………………………………………………………………………

    Serial No. : ……………………………………………………………………………………………………………………

    Last Calibration date : ……………………………………………………………………………………………………………………

    Last Calibration due date : ……………………………………………………………………………………………………………………


    Instrument Part / Accessories (please give thick on the box) *
    □ Charger □ Perforator Head Lid
    □ Casebox □ Dust Cover
    □ Other please mention ………………………………………………………………………………………………………………………………………………………………………………………………
    Customer Note (plase give thick on the box) *
    □ Calibration □ Repair □ Other notes please mention ……………………………………………………………………..
    ………………………………………………………………………………………………………………………………………………………………………………………………………

    ………………………………………………………………………………………………………………………………………………………………………………………………………

    (sign, name, date, stampel)

    Customer

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