Online Service Request Logging Form

This form is intended for use by customers needing to request new service. In order to check on the status of an existing request or to initiate urgent requests for new service, please call 800 227-9770 option 3. For Vacuum Products please call 800 882-7426 opt 3

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.

For technical support related to Keysight Technologies, or the former Agilent Electronic Measurement Products please call (800) 829-4444 or email usa_orders@keysight.com.

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

* An entry or selection in this field is required

Please select the coverage:*

Company Name*

Given or First Name*

Family or Last Name*

Work Telephone Number*

Work Phone Extension

Alternate Telephone Number (Mobile/Lab)

Alternate Phone Extension

Email Address*

Please Select Your Preferred Method*

Service Request

Service Type Requested*

Detailed Problem Description*

Please include as much detail as possible, this will help minimize potential delays.

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?*

Instrument Location

Address 1*

Address 2

Building / Lab #

City*

State/Province*

ZIP / Postal Code*

Country*

Billing Address

Same Company & Address as Instrument Location

Company

Address 1

Address 2

City

State/Province

ZIP / Postal Code

Country