Request for Service

Instruction

In the interest of everyone health and safety, please disinfect and/or sterilise your item(s) for repair
Pack the item(s) for repair in suitable packaging material to protect against damages during transportation.
Complete and submit the form
We will call you to arrange for collection within one working day

Clinic Detail

Name of clinic*:

Address of clinic*:

Postcode*:

Date*:

Your Name*:

Contact Number*:

Fax Number:

E-Mail:*:

Fault Information

Please provide a clear description of the fault together with any other relevant information.

Model	Serial No	Description of Fault
			Warranty
			Warranty

For warranty case, please provide evidence of purchase (copy of invoice)

Repair Instruction

Repair ** Repair if not exceeding SGD (excluding GST) Quote required

** We want to repair your equipment(s) as efficiently and as economically as possible. We shall assume that we have your authority to proceed with the repair provided that the cost does not exceed 50% of a similar replacement product. We shall consult you if the cost is expected to be higher thant this and seek your agreement if the repair should proceed.

Terms

By submitting this form, you shall be deemed to accept unconditionally and without amendments the following terms

You are responsible to ensure that your equipment(s) are packed in a container of sufficient strength so as to protect against damage in the course of transportation. We do not accept any claim for damage caused during delivery to W&H Dental-Mechanik (Asia) Pte Ltd.
Should you refuse the repair for equipment(s) not covered under warranty, we reserve the right to charge an evaluation fee of SGD 45.00 excluding GST per instrument or SGD 90.00 excluding GST per sterilizer.

I understand and accept all the terms associated with this request.

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