Technical Support Form
First Name*
Email*
Phone Number
Company Name*
Street Address
City*
Country* AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicDR CongoEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts & NevisSaint LuciaSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSt. Vincent & GrenadinesState of PalestineSudanSurinameSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe
Postal Code*
Product Model* AccessoryAVCC&DCamera SystemConsumableDC-120DHC-6TDHC-6TADHC-6TDDisintegrationDisso-3Disso-7DSCFCD-24DFDC-12DFDC-12DBFDC-12EFDC-24DBFDC-6AFDC-6EFDC-6TAFilter ChangerFriabilityFTCHardnessMDSPermeaPadPermetroSCRSDC-6ESFDC-6ESLT-600Spare PartSuper-4Tap DensityUDT-818-12UDT-818-15UDT-818-18UDT-818-8Other
Instrument Age*
Version*
Serial Number*
Describe the problem (include as many details as possible)*
How is the instrument setup? What is it connected to?*
How long did the instrument work before the problem started?*
Please describe any recent repairs or part replacements*
What application is being used with the instrument?*
Please describe your troubleshooting steps*
Attachment