Service Request — CANI Optical Systems, Inc.

Please complete the following request form below and a CANI Optical Systems Customer Service Specialist will be in contact with you shortly to assist you with your Service and Repair request.

For immediate service, please contact us at 888-799-CANI (2264).

Name

First Name

Last Name

Phone

Please indicate the best contact number to reach you with any questions, updates, and communication

(###)

###

####

Email Address

Best Time to Contact You

Please indicate the best time(s) to contact you regarding your service request.

Make

Please indicate the Manufacturer of the device requiring service.

Model

Please indicate the model of the device

Serial #

Type of Service

Problem Description

Disinfected/Sterilized

Has the device been effectively disinfected and/or sterilized?

YES

UNSURE, Please contact me