Support Form

First Name*

Last Name*

Company Name*

Country / Region*
—Please choose an option—AlbaniaAmerican SamoaAndorraAngolaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBritish Indian Ocean TerritoriesBulgariaCambodiaCanadaCentral African RepublicChadChileChinaColombiaCongoCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDubaiEcuadorEgyptEl SalvadorEstoniaEthiopiaFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGuatemalaHong Kong (China)HungaryIcelandIndia Mumbai & OtherIndia SuratIndonesiaIranIraqIreland {Republic}IsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthLaosLatviaLebanonLiechtensteinLuxembourgMacau (China)MalaysiaMauritiusMexicoMonacoMozambiqueNamibiaNepalNetherlandsNew ZealandNigeriaNorwayPakistanPanamaParaguayPeruPhilippinesPolandPortugalPuerto RicoRomaniaRussian FederationRwandaSierra LeoneSingaporeSlovakiaSomaliaSouth AfricaSpainSri LankaSwazilandSwedenSwitzerlandSyriaTaiwan (China)TanzaniaThailandTogoTurkeyUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayVatican CityVenezuelaVietnamZambiaZimbabwe

Phone Number*

Email Address*

Ticket Category*
—Please choose an option—Hardware IssueSoftware IssueLicense IssueTrade/Profile IssueShipment IssueRMA RequestSpare Parts RequestAMC RequestTraining RequestQuotation RequestPlace OrderOthers

Subject*

Problem / Request Description:*

Machine Type*
—Please choose an option—GalaxyDiaExpert SL/MLDiaScan S/S+DiaMobile XL/XXLNano/AtomDiaMensionDiaMension HDDiaScribe SL/MLStrategistQuazer II/IIISarine LightSarine LoupeSarine ColorSarine ClarityStationOthers

Operation System
—Please choose an option—Win 10Win 11

Machine Serial Number

Laser Serial Number

Marker Serial Number

Product & Version
—Please choose an option—GalaxyeGradingTraceabilityAdvisor 7.xAdvisor 8.xInstructor 2.xInstructor 3.xInstructor 4.xDiaVision 5.xDiaScribe 2.xXCaliber 1.xXCaliber 2.xGal Setup 4.xGal Setup 6.xStrategist 3.xQuazer 3.xQuazer 4.xAdvisor Pixel 1.xAdvisor Tender 1.xRough Viewer 1.xClarity 1.xClarity 2.xColor 1.xColor 2.xLoupe 1.xLoupe 2.xLight 1.xLight 2.xLight 3.x

Attach Documents

Max upload file: 5MB. File types allowed: pdf, jpeg, png, doc, docx, csv, xlsx, xls ,avi, c2v, txt, zip