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Advanced Exchange Request

Date:
Advanced Exchange #
(Please reference this number when sending in your Core Exchanges.)
Company Name:
Ship to address: 
Attention:
Street Address:  City:
State:   Zip:
Bill to Address:  same as Ship to Address
Company Name:
Attention:
Street Address:  City:
State:   Zip:

Contact Name*:  (* required fields)

Phone Number*: Email Address*:
Request Items for Exchange:
Manufacturer Device Part Quantity
1.
2.
3.
4.
5.
6.
Your Reference or PO #: (Required before order will ship)
Core returns, with CORE TAGS, must be received within 14 days to prevent
additional billing
Incomplete and Non-Repairable cores will result in additional charges
Contact your sales rep to arrange for an Outright Purchase of these items
Comments (Please include any special requirements, such as software revision level):

 

 
 

 

Please complete the form and click submit at the bottom of the page.   A copy will be emailed to the address provided

 

Your unique Advanced Exchange number is displayed at the top of this form. Please use this number when communicating with Select Biomedical about your repair.

 

 Thank you!

Contact Us: Select POS & Peripherals  LLC  7275 Bush Lake Road Edina, MN 55439 1.866.559.3500  information@selectpos.com

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