Repair and/or Warranty Request Sheet
Company:
Contact:
Address:
Tel No:
Fax No:
Reference / Order numbers
Installation data
Customer reference
Delivery date
Purchase order No
Date of installation
MMI No
Date of failure
Type of order
…
Repair
…
Calibration
…
Exchange
…
Return (after exchange)
…
No warranty
…
Replacement
…
Investigation/Quote
…
Report needed
…
Warranty
…
Other:
…
Extended warranty
Sensor information
Transmitter information
Model
Model
Serial No
Serial No
Tag No
Tag No
Flange type
Power supply
Sensor condition
Process conditions
Tubes empty
…
yes /
…
no
Medium
Case empty
…
yes /
…
no
Chemical formula
Decontamination statement
…
yes /
…
no
Maximum temperature
Type of cleaning material
used
Operating pressure
Warning! For the health and safety of our goods handling/inspection department, a Decontamination Statement MUST be
filled in with this form. Please be specific with the information provided.
Calibration data
Maximum process flow
Primary output
Units =
4mA =
20mA =
Secondary output
Units =
4mA =
20mA =
Frequency output
1 pulse =
Freq. =
Rate =
Description of failure
Remarks/Instructions
Return (shipping) instructions
Ship to address:
Shipped by:
Ship date:
Remarks
Please do not fill in the shaded areas
09rtrn2.fm Page 58 Tuesday, March 2, 1999 9:47 AM
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