SERVICE REQUEST FORM Please fill out this form to send an item to Waltz-Dettmer for repair. A work order number will be automatically generated and you will receive an e-mail with this number and the information you provided. Print and place the e-mail in the box with your item to be repaired and ship it to Waltz-Dettmer Supply.
Through August: Repair orders (limit two per company) initiated through the Internet using this Service Request Form will receive free labor. All you pay for is the parts.

            
                       Name: 
               Company Name: 
                 Address(1): 
                 Address(2): 
                       City:          
                      State:          
                        Zip:          
             E-mail address:          
                  Telephone:          
                        Fax: 
        Description of Tool: 
               Manufacturer: 
               Model Number: 
              Serial Number: 

     Describe the problem you are having:
     
     
     Is item under warranty?   Yes  No