online service request...

Request Service | Thank you for your interest in submitting an online service request. Please fill out the form below. One of our representatives will contact you shortly after to discuss your request.

Facility Name:

Facility Address:

City: :

State:

Zip:

Contact Name:

Contact Phone:

Contact Email:

Purchase Order #:

Items to be returned for Compliance Service
(please provide ALL information listed below for each unit being submitted)

	Manufacturer	Model	Serial Number
Unit 1
Unit 2
Unit 3
Unit 4

Additional Comments / Instructions

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"Your complete satisfaction is our professional guarantee to you, our valued customer.”

ACT Services
1428 Pacific Street
St. Paul, MN 55106

phone: 651-493-8255
fax: 651-493-8256
biomed@actservice.net