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Maintenance & Repair Request Form

ORR Safety Online Service/Maintenance Request

In order to process your service request, please be sure to have the following information:

  • Model Name or part number
  • Serial number of the item you are returning
  • Purchase order number or credit card information

Service Request Form

Serial #

Customer Information

Contact Name
Company Name
Phone Number
Fax Number
Billing Address
Shipping Address
Please list units being returned:
Esitmate required before repair?
Reasons for Return
Special Instructions

Shipping Method Requested for Return

Collect Account#

Please Note

  • Once the form has been submitted, you will receive a RMA within 24-hours. Please include the RMA with your return. You will also receive shipping information on where to send your return.
  • There is an $85.00 estimate charge per instrument. Estimate fee is waived if unit(s) is repaired, or a new unit(s) is purchased, as a replacement, from the service department.
  • Shipping charges are additional and are generally pre-paid and added to the invoice.
  • Payment must be by credit card or purchase order.
  • DO NOT return compressed gas cylinders with repair.
For more information, call 1-800-697-4677 ext. 1086 to speak with a technical service representative.
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