Repair Request

Equipment Repair Service Request

Please Fill Out Information Below or Download PDF

If you choose to download the PDF please fill it out completely and send it by email to heidi@orsolutionsusa.com.

If you need assistance with filling out the repair request form or have questions about your repair, please call 508-341-3641.
*Purchase Order #*
*Repair*
- Needed ASAP - Begin repair
- Approval required prior to repair
Billing Information

Today's Date:
*Date*
*Name*
*First Name *Last Name
*Your Title*
*Facility*
*Department*
*Email*
*Phone*
Extension
Fax
*Billing Address*
Street Address Address Line 2 City State ZIP Code
*Billing Information*
- Ship to billing address
- Ship to different address
Shipping Information
If different from billing
*Name*
First Last
*Department*
*Shipping Address*
Street Address Address Line 2 City State ZIP Code
Please List Items to be Repaired
Please List Items to be Repaired
Qty Mfg/Model/SN Surgeon or Operating Room Complaint
Confirm
- I am ready to ship my equipment for repair. Please have a product repair consultant contact me.
Shipping Method
*Ship Method*
- I am shipping my equipment priority overnight for delivery by 10:30am
- I am shipping my equipment standard overnight for delivery by 3:00pm
- I am shipping my equipment 2-day air
Additional Information
Upload an image of your damaged equipment
Image of damaged equipment
Drop files here or

Max. file size: 512 MB.
Ship Items to O.R. Solutions Repair Processing Center

O.R. Solutions
Repair Processing Center
1225 Providence Rd
Whitinsville, MA 01588
Human Verification
Email
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Download

Qty	Mfg/Model/SN	Surgeon or Operating Room Complaint