Handpiece Work Order

  • Please Print out this work order form and the free mailing label.
  • Your repaired handpiece will be shipped back via priority mail within 48 hours.
  • Upon your request we offer a postage free mailer.
Name________________________________   

Address______________________________  

Telephone____________________________

FAX_________________________________

The following handpieces are enclosed:

 City__________________________________

State___________________Zip___________

Email________________________________
Product:                                         Serial# :                                                       Price$

 

Describe Problem:

 
Product:                                         Serial# :                                                       Price$

 

Describe Problem:

 
Product:                                         Serial# :                                                        Price$

 

Describe Problem:
                                                                                                                     Sub-Total
                                                                                                       Less 2% for Cash
                                                                                                                             Total
[ ] Charge                                           [ ] Check Enclosed                              [ ] Please Bill Me

Visa/MasterCard Number below                                                                        Expiration Date

 Mail to : PPEC 3460 Four Lakes Ave. - POBox 520 - Linden, MI 48451-0520

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