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PMI Service Request Form

Please complete this form to send your product technical support request electronically to PMI. When finished, press the submit button at the end of the page.

Customer Information:

Title:
-- Mr. Mrs. Ms. Dr.

First Name:

M. I.

Last Name:

Company Name:

Mailing Address:

City:

State:

Postal Code:

Country:

Phone:

Fax:

Email:

Preferred Method of Contact:

Phone

Email

Fax

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Service Support Information

Instrument Name:

Purchase Date:
Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Before 1980 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Model No.:

Serial No.:

Special Features Added to Machine:

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Date Available For Service:
Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2005 2006 2007 2008 2009 2010

Duration of Problem:

Problem/Work To Be Done:

Please only press the Submit button once. It may take a moment or two to submit your information.

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1-800-9 POROUS
(1-800-976-7687)
Ph: 607-257-5544
Fx: 607-257-5639
pmieurope@pmiapp.com

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