Repairs Service Booking Form

0488 048 709 | sales@paramountdentalrepairs.com.au

PARAMOUNT

DENTAL REPAIRS

$0.00

Contact Person

Practitioner Name

Practice Name

Phone

Return Address

Street / PO Box

Suburb / City

State / Province

Post / Zip Code

Country

Please Select:

Equipment details

Make

Model

Serial number

Fault (if known)

Decontamination Declaration:

I confirm that all items have been sterilised

Contact Name

Date

I acknowledge and agree that to provide a free quote all items will be disassembled for investigation and diagnosis. If the repair quote isn't accepted items may be returned in disassembled state.

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Repairs Service Booking Form

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