BMES

Bio-Medical Equipment Service Company | BMES

2709 South Park Road
Louisville, Ky 40219
(888) 828-2637

Online Repair Form

HEADING_TITLE

If you prefer to download a copy of our repair form, click here.

Required Fields*

Step 1

Your PO#:

Step 2

Facility Name:*

Shipping Address:*

City:*

State:*

ZIP Code:*

Billing Name:*

Billing Address:

City:

State:

ZIP Code:

Contact Name:

Phone Number:

Phone Ext:

Email Address:

Equipment #1 (List More Equipment)

Equipment Manufacturer:

Model #:

Serial #:

Channel #:

Failure:

Step 3

Shipping Method:

Extended Warranty:

Please add an additional 1 year extended warranty for $75.00 per transmitter for the following serial numbers: