Parkell Repair Service Form PDF Details

Parkell understands that your dental repair needs must be met quickly and efficiently. That's why we offer a Repair Service Form, an easy-to-complete form for requesting repairs and addressing them within a timely manner. Whether it's due to daily wear or unexpected damage, Parkell is dedicated to providing you with comprehensive service every step of the way. With our Repair Service Form, you can feel confident that any repair needs will be handled swiftly and with care – so you can get back to work in no time!

Form NameParkell Repair Service Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesparkell repair service form, warranty, waived, pre

Form Preview Example

Parkell Repair Service Form

Send repairs to: Parkell, Att: Repair Department 300A Executive Drive, Edgewood, NY 11717

Phone: 631-249-1134 • Fax: 631-249-1242 E-mail:

**Please fill out this form and include a copy of it with your repair.

Name: ________________________________________________________________________________

Address: ______________________________________________________________________________

City: ______________________________________________ State: __________ Zip: _______________

Person in your office we can contact about this repair: __________________________________________

Phone: ____________________________________ Fax #: ______________________________________

E-mail: ________________________________________________________________________________

Preferred method of contact:




Office hours: ___________________________________________________________________________

Device: ________________________________________________________________________________

Serial #: _______________________________________________ Date of Purchase:__________________

Problem with Device:______________________________________________________________________



An $80.00 bench fee will be charged for most non-warranty repairs; if you go ahead with the repair the $80.00 bench fee with be waived.

Waive bench fee and repair unit?



I pre-authorize Parkell to repair my device if the repair is under $_______________. If the repair is over the

authorized amount we will contact you first before proceeding with the repair.



Parkell Use Only:

Date Received: _____________ By: _____________________________________________________________

Accessories Received: _________________________________________________________________________


Bench Test Fee: _____________ Approved By: ___________________________ Date Approved: __________

Repair Estimate: _____________ Approved By: ___________________________ Date Approved: ___________

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If you want to complete this document, make sure that you type in the right information in every single field:

1. To begin with, while filling in the Edgewood, beging with the page that contains the following blank fields:

parkell label for repair conclusion process explained (stage 1)

2. After performing this section, go to the next stage and fill in all required particulars in all these blanks - An bench fee will be charged for, Waive bench fee and repair unit, Yes No, I preauthorize Parkell to repair, Date, Signature, Parkell Use Only, Date Received By, Accessories Received, Bench Test Fee Approved By Date, and Repair Estimate Approved By Date.

Repair Estimate  Approved By  Date, Date Received  By, and I preauthorize Parkell to repair inside parkell label for repair

It's very easy to make an error when filling in the Repair Estimate Approved By Date, so make sure to go through it again before you'll finalize the form.

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