UIC instrument repair, service, maintenance request
Only for services performed by Rob Cinq-Mars. Please be specific in description!
First Name *
First name of responsible person (Faculty, PI or Lab Manager)
Your answer
Last Name *
Last name of responsible person (Faculty, PI or Lab Manager)
Your answer
Requestor
Full Name (If not same as above)
Your answer
Email *
Your answer
Phone
Telephone number for point of contact.
Your answer
Description *
Explain problem or service needed
Your answer
Building *
Where instrument / service needed
Your answer
Room *
Room number where instrument / service needed
Your answer
Priority *
Required
Organization
Department *
Service needed *
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