Online Service Request Logging Form

Scheduling service on your Agilent Technologies instrument is a simple process that takes only a few minutes.

Please note the following:
The information collected will only be used to facilitate the scheduling of your service call.
Completion of a separate form will be necessary for each instrument requiring service.
If you are unable to complete the process, need to cancel or schedule a service call, please contact Agilent Customer Support at 800-227-9770 select option 3.

Customer Information - This should be the end user of the equipment

Please select the coverage: *

Company Name: *

Given or First Name: *

Family or Last Name: *

Work Telephone Number: *

Work Phone Extension:

Alternate Telephone Number (cell/lab):

Alternate Phone Extension:

Email Address: *

In the event Agilent needs to contact you to verify any information, what would be the preferred contact method?: *

Service Request

Service Type Requested: *

Detailed problem description:
For the next section, it is extremely important to include as much detail as possible related to your request, this will help minimize potential delays. For repair service detail the problem or symptoms, any troubleshooting attempted and error codes observed. For qualification services include in your note if software qualification is needed. Please type your detailed problem description with all pertinent information in the box below:

Instrument Description

Instrument Type: *

Choose a single instrument type that best describes your instrument or system. If you have a GC/MS or LC/MS system please enter the model and serial number for the impacted component.

Model Number: *

Serial Number: *

If you entered a GC or LC Model number above, does it include a Mass Spectrometer detector? *

Software Revision *New Information Requested*

If your system is controlled by Agilent software, please enter the model and revision number below to ensure proper resource assignment.

Software Model#/Description:

Example: M8301AA OpenLAB - hint: check Windows Add/Remove Programs or in software click Help-About

Revision number:

Example: OpenLAB CDS 2.0

Instrument Location

Address 1: *

Address 2:

Building / Lab #:

City: *

State/Province: *

ZIP / Postal Code: *

Country: *

Additional Note: Registering and logging onto the Agilent website will enable "auto-fill" of your designated profile fields in the form above for future requests.

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