OmniCure® UV Bonding | Equipment Servicing Form

All fields are required to be filled out.

First Name:

Last Name:

Company Name:

Title:

Ship to Address:
(Indicate the address where a repaired product would be returned to from EXFO)

Once you receive the repaired product from EXFO, will you be redirecting it to another country?

Not Applicable
Canada
United States
Latin America
Europe
Africa
Middle East
Other

Other:Please Specify

City:

State/Prov:

Postal/Zip Code:

Country:

Tel Number:

Email:

Federal Tax ID (IRS) Number:
(For US customers only)

Reason for return:

Calibration
Repair
Upgrade
Credit
Return of Demo
Lamp Failure
Return Used Lamp For Recycling
Other

Other:Please Specify:

OmniCure® is the recognized global leader in bonding systems for precision assembly using light-cured adhesives. With representation in more than 70 countries, OmniCure® UV/Visible and LED Spot Curing Systems are the most advanced in their field.