Request A Loaner

To Request A Loaner, please complete the form below. Either Print, complete and fax to 1.905.567.5987 or simply fill in and submit. Fibertech will respond as quickly as possible to your request.

Download Form – Print Form

Please fill in form and return with equipment to be repaired:

    Hospital Name*
    Person to Contact about Loaner*
    P.O. #:
    Model #:
    Manufacturer Requested:
    Phone Number*:
    Email Address*:
    Ship To*:

    Services

    Endoscopes

    ScopeControl

    Endoscopic Accessories

    Cleaning, Disinfection & Storage

    Light Cables

    DoviScan

    Guide Control