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MAXIM PIPETTE QUOTE REQUEST FORM
Please fill out this form and a quote will be emailed to you shortly
Institution:
*
Department:
PI. Name*:
Contact Name:
*
Contact Email:
*
Confirm Contact Email:
*
Telephone:
*
Bldg:
RM No:
Street Address:
City
*
State
*
Zip Code
*
SERVICE REQUESTED
*
On-Site
Mail-IN
Other
Level of Service
*
Basic Level
Premium Service
Platinum Service ISO 17025 As Left Data
GOLD Service ISO 17025 As found/ As Left Data
GOLD Service ISO 17025 As found/ As Left Data
Pipettes (Basic Service)
Single Channel
8-Channel
12-Channel
Pipet-Aid/ Repeaters
Diluters
Balances
Other (parts, etc.)
Current Total for Basic Service:
$0.00
Calculate
Desired Service Date/ Ship Date:
*
+
Notes: