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Southwestern Biomedical Electronics
2511 S. Harvard Ave Tulsa, OK 74114
REPAIR FORM

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Description of Problem:	Return Shipping: Please select one
	If selection is not made all items will be shipped back via 2nd Day prepaid and billed on invoice

Please select if you would like this repair expedited Expedite Repair - Additional Charge $100.00 Check to Include Expedite Repair