First Name

Last Name

Phone

Email

Name of Institution

RMA Number

Is your instrument under warranty? YesNo

What was the purchase date of your instrument?

If your instrument is out of warranty, please supply a PO number for repair and shipping charges

What is the model of your instrument? Film Array RAZOR Other Listed are our legacy and current instrument offerings

Instrument Serial Number This number is located on the serial label on the instrument.

Laptop/Computer Serial / Service Number This number is located on the computer that came with the instrument.

Laptop Administrator Login Username This is needed to QC test your instrument.

Laptop Administrator Password This is needed to QC test your instrument.

Instrument Notes

What was the purchase date of your kit or accessory?

What kit or accessory are you returning?

What is the Lot No. on the kit?

How many kits are you returning?

Kit or Accessory Notes

Which method of decontamination was used?

What chemical, infectious, toxic or radioactive substances have been in contact with this product? (Also indicate if flammable or corrosive.)

What BioFire assays have been run on this instrument within the last 6 months?

Submitter First Name

Submitter Last Name

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