DaVita Service Request Form

Per DaVita Policy, all requests for service will now have to a Coupa PO number created in Coupa for us to allow us to transact, so we may invoice against it. Please make sure you both populate a PO for us in Coupa and submit this form with the corresponding PO number. Requests for service require you to submit this form to us with a PO number issued to us in Coupa or it risks delayed service. We transact as Television Hospital Products in Coupa. Any requests for service or emails without issuing us a PO number in Coupa will be delayed until it is issued. Thank you.