Request Equipment Repairs Equipment Repair Request Please complete the form below in order to request any equipment repairs. Person Placing Request: * RequiredLab Association: * RequiredPhone Number:Email Address: * RequiredEnter your full email address, including the '@'.Is this an emergency ? * RequiredNoYesType of Equipment: * RequiredBrand of Equipment: * RequiredModel Number: * RequiredSerial Number:Room Number: * RequiredBuilding * RequiredSESSELMBRBOther:Please enter building if not in menu above. UIC Tag Number:Please enter tag number if known. Description of Problem: * RequiredPlease be as detailed as possible. Account to Charge to: * Required This iframe contains the logic required to handle Ajax powered Gravity Forms.