Metal Samples Company MS4500E-HC, Operator'S Manual, Page: 29 / 34

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C. Instrument Repair Form
This form may be photocopied for use when returning an instrument to Metal Samples for repair.
Please fill in all known information and enclose a copy of the completed form with the instrument.
General Information
Model
Number
RMA
Number
*If known.
Serial
Number
Date of
Purchase*
Contact Information for Repair
Contact
Name Company
Phone
Number
E-mail
Address
Return Shipping Information
Recipient
Name* Company*
Return
Address
*If different than above.
Reason for Return. (Provide as much detail as possible. Attach additional pages if required.)
Invoice Instructions (For non-warranty repairs)
Invoice me for the repair
(Requires an open account with Metal samples.)
Contact me for credit card information
(For security purposes, do not list credit card information on this form..)
Reference
PO#