ELECTRONIC INSTRUMENT REPAIR FORM

 
We can Pick it up, Repair it, and Return it to you with a Call Tag Request!

Please give us a call at 800-437-1146, send us an email at info@pollardwater.com or complete the following form so we can assist you with repairing your electronic instrument. Click here for printable PDF form.

Check the UPS Call Tag Button if you would like us to issue one to have your instrument(s) picked up. Give us the information below and we will do the rest! NOTE: All Freight Charges will be simply added to your final invoice.

* denotes a required field
Issue a UPS Call Tag to have my Instrument(s) Picked Up.
This is an Emergency Repair!
I need an Estimate before any repairs are made.
I think this should be covered by my Warranty.
       

Instrument Purchased

Original Invoice #
 
How do want your Instrument(s) Returned?
INVOICE TO

First Name*

Last Name*
Company Name

Address*

City* State*
Country* Zip Code*
Telephone Ext
Best Time to Call
eMail Address*
SHIP TO

First Name*

Last Name*
Company Name

Address*

City* State*
Country* Zip Code*
Telephone* Ext
OTHER INFO
PO Number
Type of Instrument
Serial Number
Describe the
Instrument's
Problem(s)
Enter the security code shown*:
   
 
SHIP YOUR INSTRUMENT TO:
POLLARDWATER REPAIR CENTER
200 Atlantic Avenue
New Hyde Park, New York 11040