Maxim Environmental - Rentals, Sale, Support

EXCEPTIONAL SERVICE AND SUPPORT

MAXIM Service Request Form

General info

First Name*

Last Name*

Company Name

Email*

Phone*

PO#/Project#

Equipment Return Address

Address*

City*

Province*

Postal Code

Billing Address

Address

City*

Province*

Postal Code

Please check if pick-up/delivery is required

When will this be available for Pick-up?

*Pick-up/Delivery are only available in GTA and Ottawa

Equipment Pick-up and Delivery Address

Address

City

Province

Postal Code

Services info

Instrument Manufacturer & Model:*

Serial Number:*

Service Required:*

Please describe the issues you are having with the instrument/equipment (this will assist us in assessing your return):

Please list any accessories you are including:

Add another Service item

Answer: 2+12=?*

RKI Eagle 2 - Hydrocarbon

RKI Eagle 2 - Hydrocarbon

Fieldpro Peristaltic

Fieldpro Peristaltic

Horiba U-52

GEM 5000

DustTRAK II Model 8530

DustTRAK II Model 8530

Oil/Water Interface Meters

Oil/Water Interface Meters

Please, enter a valid value