FEATURON - Pipette Service Request Form (PSRF)

Request Number

Request Date

Priority Level

Status

🏢 Laboratory / Customer Details

Customer / Institution Name *

Department *

Lab / Room / Location

Contact Person

Mobile / Phone

Email Address

Address & City

⚙️ Service Scope & Instructions

Service Type

Target Completion Date

Special Handling / Customer Remarks

🧪 Pipettes Submitted for Service (0)

#	Make	Model	Serial No	Channel Type	Volume Range ()	Specific Issues

🛡️ Decontamination & Biosafety Declaration: The sender certifies that all micropipettes listed above have been thoroughly cleaned, surface-disinfected, and autoclaved/decontaminated where applicable, and are free from hazardous biological, toxic, chemical, or radioactive substances.

Submitted by (Customer Representative / Lab In-Charge)

Signature: __________________________ Date: ________________

Received by (Featuron Service Engineer)

Signature: __________________________ Date: ________________