Injector Service Request

Precise Biomedical, Inc. offers the following for Contrast Injector Preventative Maintenance.

PM Only:
  Our rates on standard non contract PM's are $550.00 per injector plus travel.

3 Year PM Agreement:
  Your rate of $550.00 plus tavel expenses is locked in for 3 years. Plus we give free technical support, no after hour charges.

     If you are interested in contrast injector preventative maintenance, please fill out the below form as accurately as possible and then click the submit button at the bottom of the page. If you already have this data in anther format, then click Here to email your document to Precise Biomedical. After your infromation has been received, Precise Biomedical, Inc will contact you to decide the next appropriate steps.

First Name:		Last Name:
Facility Name:
Address:
City:		State:
Zip Code:
Phone Number:		Fax Number:
Email Address:
Nearest Airport:

Are the Injectors at Multiple Locations?
Is the "bill to" the same as injector locations?
Interested in PM only Agreement
Interested in 3 year PM Agreement

Equipment Information:(optional)

Injector Make:	Model Number:	Department Location	Department Telephone Number
Injector Make:	Model Number:	Department Location	Department Telephone Number
Injector Make:	Model Number:	Department Location	Department Telephone Number
Injector Make:	Model Number:	Department Location	Department Telephone Number
Injector Make:	Model Number:	Department Location	Department Telephone Number