Dental Slowspeed Repair
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 Avtec Dental Repair Request Form

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389 Johnnie Dodds Blvd. Suite 113
Mount Pleasant, SC 29464 U.S.A.
ph. 877.336.8259 / fx. 843.884.3325
 
 
Full Name:
Email:
Address:

Fax:
City: Phone:
State:
Zip: Contact Person:
Item Make
Serial #
Repair as Needed
Estimate
Warranty
1)
2)
3)
4)
5)
Pickup Information
I will ship myself. (Print out the Free US Postage Paid Business Reply Label)
 
UPS Next Day (Label will be faxed or emailed)
  
Fax Email
       
Additional Comments
Please Print out two copies of this form:
1) For your records
2) To include with repair package


security seal
Credit card and PayPal accepted
UPS
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