FROM:
RETURN
BILL TO:
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CUSTOMER/USER MUST SUBMIT MATERIAL SAFETY SHEET (MSDS)
OR COMPLETE STREAM COMPOSITION, AND/OR
LETTER CERTIFYING THE MATERIALS HAVE BEEN DISINFECTED AND/OR DETOXIFIED WHEN RETURNING ANY PRODUCT,
SAMPLE OR MATERIAL THAT HAVE BEEN EXPOSED TO OR USED IN AN ENVIRONMENT OR PROCESS THAT CONTAINS A
HAZARDOUS MATERIAL
ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICAL WITHOUT THE MSDS
WILL BE RETURNED TO SENDER C.O.D.
FOR THE SAFETY AND HEALTH OF OUR EMPLOYEES. WE THANK YOU IN
ADVANCE FOR COMPLIANCE TO THIS SUBJECT.
SENSOR OR CIRCUIT BOARD ONLY:
(Please reference where from in MODEL / SER. NO. Column)
1. PART NO. _____________________________1. MODEL ____________________________________1.
SER. NO. __________________
2. PART NO. _____________________________2. MODEL ____________________________________2.
SER. NO. __________________
3. PART NO. _____________________________3. MODEL ____________________________________3.
SER. NO. __________________
4. PART NO. _____________________________4. MODEL ____________________________________4.
SER. NO. __________________
PLEASE CHECK ONE:
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REPAIR AND CALIBRATE
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DEMO EQUIPMENT NO. ______________________________
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EVALUATION
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OTHER (EXPLAIN) ___________________________________
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REPLACEMENT REQUIRED?
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YES
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NO
_______________________________________________________
DESCRIPTION OF MALFUNCTION:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
WARRANTY REPAIR REQUESTED:
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YES-REFERENCE ORIGINAL ROSEMOUNT ANALYTICAL ORDER NO. _______________________________________________
CUSTOMER PURCHASE ORDER NO. ________________________________________________________
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NO-PROCEED WITH REPAIRS-INVOICE AGAINST P.O. NO._________________________________________________________
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NO-CONTACT WITH ESTIMATE OF REPAIR CHARGES: LETTER
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_________________________________________________
PHONE
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________________________________________________
NAME___________________________________________________________
PHONE______________________________________________
ADDRESS_______________________________________________________________________________________________________________
_____________________________________________________________________
ZIP______________________________________________
RETURN AUTHORITY FOR CREDIT ADJUSTMENT [Please check appropriate box(s)]
■
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WRONG PART RECEIVED
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REPLACEMENT RECEIVED
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DUPLICATE SHIPMENT
REFERENCE ROSEMOUNT ANALYTICAL SALES ORDER NO. _____________
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RETURN FOR CREDIT
RETURN AUTHORIZED BY:
__________________________________________
WARRANTY DEFECT ______________________________________________________________________________________________
_________________________________________________________________________________________________________________
24-6047
RETURN OF MATERIALS REQUEST
•IMPORTANT!
This form must be completed to ensure expedient factory service.
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Rosemount Analytical Inc.
Uniloc Division
2400 Barranca Parkway
Irvine, CA 92606 USA
Tel: 1-800-854-8257
Fax: (949)-474-7250