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Describe any special needs that you have

My interest in the selected product is for(Required)

I am interested in the below Products

(Check all that apply)

Handheld Instruments

Alco-Sensor FST® Passive Screener

Alco-Sensor® VXL

Alco-Sensor FST®

Alco-Sensor® IV

Alco-Sensor® IV with Memory

Alco-Sensor® III

SoToxa Mobile Test System

Desktop Instruments

Alcomonitor CC®

Intox DMT®

Intox DMT® Dual Sensor

Intox EC/IR® II

Intox EC/IR® II.t

Portable Instruments

Alco-Sensor® VXL with Printer

RBT VXL

Alco-Sensor® VXL @Point Of Arrest

RBT IV

Recertifications

Alco-Sensor® VXL Recertification

Alco-Sensor FST® Recertification

Alco-Sensor® IV Recertification

RBT IV Recertification

Alco-Sensor® IV with Memory

Alcomonitor CC® Recertification

Intox EC/IR® II Recertification

Intox EC/IR® Recertification

TrueCal II Recertification

Instrument Inspections

Alcomonitor CC® Inspection

Intox EC/IR® Inspection

Alco-Sensor® III Inspection

Alco-Sensor® IV Inspection

Alco-Sensor® IV with Memory Inspection

Alco-Sensor FST® Inspection

Extended Warranty

Intox EC/IR® II Extended Warranty

Alco-Sensor® III Extended Warranty

Alco-Sensor® IV Extended Warranty

Alco-Sensor® IV with Memory Extended Warranty

Alco-Sensor FST® Extended Warranty

RBT IV Extended Warranty

Alco-Sensor® VXL Extended Warranty

RBT VXL Extended Warranty

Intox EC/IR® II.t Extended Warranty

Intox DMT® (DMT) Extended Warranty

Intox DMT® Dual Sensor Extended Warranty

Annual Maintenance

SoToxa Annual Maintenance

Software

IntoxNet 6 (version 6.x)

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#2

Request Information

Company(Required)

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Division

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Address 2

First Name(Required)

Last Name(Required)

City(Required)

Country(Required)

Job Title/Description(Required)

State/Province/Territory

Email(Required)

Zip(Required)

Phone(Required)

Fax

Describe any special needs that you have

My interest in the selected product is for(Required)

I am interested in the below Products

(Check all that apply)

Handheld Instruments

Alco-Sensor FST® Passive Screener

Alco-Sensor® VXL

Alco-Sensor FST®

Alco-Sensor® IV

Alco-Sensor® IV with Memory

Alco-Sensor® III

Desktop Instruments

Alcomonitor CC®

Intox DMT®

Intox DMT® Dual Sensor

Intox EC/IR® II

Intox EC/IR® II.t

Portable Instruments

Alco-Sensor® VXL with Printer

RBT VXL

Alco-Sensor® VXL @Point Of Arrest

RBT IV

#3

Custom Dry Gas Standard

Company(Required)

Existing Customer

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Last Name(Required)

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Job Title/Description(Required)

State/Province(Required)

Email(Required)

Country(Required)

Phone(Required)

Zip(Required)

Cylinder Size(Required)

Value(Required)

PPM(Required)

Corrected or Uncorrected?(Required)

Quantity(Required)

Comments

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#4

Incident Form / Return Material Authorization

Bill to company information

Ship to a different address?

Yes

Company(Required)

Ship to Company(Required)

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Ship to Phone(Required)

Email(Required)

Ship to Email(Required)

Address(Required)

Ship to Address(Required)

Suite

Ship to Suite

City

Ship to City

State/Province (If Applicable)(Required)

Ship to State/Province (If Applicable)(Required)

Zip

Ship to Zip

All repairs are returned via ground service unless otherwise requested. If you would like a faster return method please select an option below.

Your account will be billed accordingly(Required)

Next Day

2nd Day

Ground

Instruments

Please choose the amount of instruments you want to return, this will generate the needed amount of information below.

Number Of Instruments To Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Instrument Model

Serial Number

Reason For Return

Note: Intoximeters reserves the right to return the instrument in the same condition as it was received along with an invoice for the appropriate checkout charge per unit, plus all shipping charges if we do not receive a response within 15 days of the e-mailed / faxed estimate.

Authorization

Choose either Repair Request A or B *(Required)

Repair Request Option A : I Authorize All Repairs

Repair Request Option B : I Request an Estimate A $40 CHECKOUT FEE WILL BE BILLED FOR EACH INSTRUMENT

Payment Option 1, 2 or 3(Required)

Payment Option 1 : No purchase order required -- work authorized by undersigned

Payment Option 2 : A purchase order number is required before checkout or repair of instrument

Payment Option 3 : Pay by Credit Card -- CC information to be collected later

PO# (For Payment 2 or 3)

Calibration

I require an ISO 17025 accredited certificate of calibration. *Only available on dry gas compatible instruments. Fees apply: $50/Hand-held and True Cal, $75/Desktop

In-laboratory tolerance, which may differ from the tolerance of your testing program, is defined by a comparison of each of three readings to the expected value, where the difference may be no greater than +/- 5% for incoming results with values over .100 g/210L, and +/- .005 g/210L for values at or under .100 g/210L, and no greater than +/- 3% for outgoing results with values higher than .100 and +/- .003 g/210L for values at or under .003 g/210L, excluding the uncertainty, unless otherwise required by the customer in writing.

Authorized By

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#1

Request a Quote

I am interested in the below Products

#2

Request Information

I am interested in the below Products

#3

Custom Dry Gas Standard

#4

Incident Form / Return Material Authorization

Bill to company information

Instruments

Authorization

Authorized By

#5

Contact Us

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