What do you want repaired?* Welding Equipment MIG Gun TIG Torch Mizer Service Date* MM slash DD slash YYYY Company Name* Account # Account #* Your Name* First Last Your Email* Enter Email Confirm Email Your Email Enter Email Confirm Email Who should we contact regarding any questions on this repair? Contact Name and Email are the same as above. Contact Name* First Last Contact Email* Enter Email Confirm Email Contact Phone*Pick Up Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pick Up Instructions, if anyBrand* Gun Model Serial number* Machine model* Make* Detailed Description of the Problem*Is there frost or an ice ball on the vessel?* Yes No What are the 2 gauges reading?Blue/white vessel pressure: Green/black service pressure: After turning the valve, does it appear there is a leak?* Yes No Did you inform the customer they may get a call from a service technician?* Yes No Deposit: Deposit required unless you have an open credit account.Repair Labor: Per hour charge with a one hour minimum.Pick-Up & Delivery Charges apply.You may be contacted to coordinate pickup and\/or delivery of repair equipment and\/or to collect the repair deposit.Repair NumberEmailThis field is for validation purposes and should be left unchanged.