Service Request

Contact Name

Email Address

Phone Number

Region Select a region New England Tri-State

Site Location (full address, building, and room number)

Issue Select an issue Arms Back Base Casters Cylinder Lumbar Seat Tilt Mech

Description of the Issue

Chair Photo Upload a photo showing area of chair requiring service.

Tag Photo Upload a photo of the manufacturer tag underneath the seat.

Click here to view an example of a manufacturer tag

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