Service Request Form

BioMEX Solutions - Service Request Form
Step 1 - Please fill in the following form:
First Name *
Last Name *
E-mail *
Institute Name *

Institute Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

BioMEX Solutions - Service Request Form
Step 2 - Upload your Data:
Upload File *

Upload a File

Cancel of
If you have a directory of x-ray image files, put them all in a zip file and upload this zip file.

If you wish to upload multiple files, simply re-click the "Upload a File" button.
Further Information
Please include any relevant information regarding your data in message field above.
Enter the message displayed in the Captcha Box to verify you are human. *
Please read our Terms & Conditions before submitting the form. Please be reminded that our fee to request our services is non-refundable. Once the services requested has been agreed by both parties, your institution is protected by our refund warranties as stated in our Terms & Conditions.

Please check the box to confirm your agreement:
Click Submit to proceed to the final payment gateway and complete your service request.

Upon submission you will receive an automated response to confirm the service request. This will include the Unique Submission ID for you request, please record this number as it should be referenced in all correspondence.

Upon submission of payment you will also receive a confirmation e-mail from WorldPay. Please also record the WorldPay Transaction ID for your reference.

BioMEX Solutions will contact you within 3 working days regarding your order and next steps.
Depending on your file size, it may take up to 10 minutes to upload your data. Thank you for your patience.
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BioMEX Solutions - Service Request Form

BioMEX Solutions - Service Request Form