Appendix G — Factory Service
G - 3
Item(s) Being Returned:
Model #
␣ ________________________________________________________
Serial #
␣ ______________________________________________________________________________________
Description:
␣ _____________________________________________________________________________________________________________________________________________________
Reason for return of goods (please list any specific problems)
␣ __________________________________________________________________________
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Name
␣ ____________________________________________________________________________________
Company
␣ ______________________________________________________________________________
Address
␣ ________________________________________________________________________________
Country
␣ ________________________________________________________________________________
P.O. Number
␣ _________________________________________________________________________
Newport Corporation
U.S.A. Office: 714/863-3144
FAX: 714/253-1800
Service Form
RETURN AUTHORIZATION #
␣ __________________________
(Please obtain prior to return of item)
Date
␣ ______________________________________________________________
Phone Number
␣ ______________________________________________
FAX Number
␣ _________________________________________________
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