Online Service Request

Online Service Request Logging Form

Initiating a new request for service on your Agilent Technologies instrument is a simple process that takes only a few minutes.

This form is intended for use by customers located in the Americas and needing to request new service. To update, cancel or check the status of an existing request, or if you need to initiate an urgent request, please call 800 227-9770, option 3.

Please note the following:

The information collected will be used to facilitate your service call.
Completion of a separate form will be necessary for each instrument requiring service.

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