Emerson 51-DO-03, 51-DO-04 Return of Materials Request, Sensor or Circuit Board only

RETURN OF MATERIALS REQUEST

•IMPORTANT!

This form must be completed to ensure expedient factory service.

FROM:			RETURN	BILL TO:
C
U		_____________________________		_____________________________			_____________________________
S
T
O		_____________________________		_____________________________			_____________________________
M
E		_____________________________		_____________________________			_____________________________
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N			CUSTOMER/USER MUST SUBMIT MATERIAL SAFETY SHEET (MSDS) OR COMPLETE STREAM COMPOSITION, AND/OR
O	S		LETTER CERTIFYING THE MATERIALS HAVE BEEN DISINFECTED AND/OR DETOXIFIED WHEN RETURNING ANY PROD-
T
	E		UCT, SAMPLE OR MATERIAL THAT HAVE BEEN EXPOSED TO OR USED IN AN ENVIRONMENT OR PROCESS THAT CON-
I
	N
C	D		TAINS A HAZARDOUS MATERIAL ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICAL WITHOUT
E
	E
T	R 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.
O
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. ________________
R			PLEASE CHECK ONE:
E
A			 REPAIR AND CALIBRATE		 DEMO EQUIPMENT NO. __________________________
S
O			 EVALUATION		 OTHER (EXPLAIN) _______________________________
N
F			 REPLACEMENT REQUIRED?  YES  NO		_________________________________________________
O
R			DESCRIPTION OF MALFUNCTION:
R			______________________________________________________________________________________________________
E
T
U			______________________________________________________________________________________________________
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N
			______________________________________________________________________________________________________
R			WARRANTY REPAIR REQUESTED:
E
P			 YES-REFERENCE ORIGINAL ROSEMOUNT ANALYTICAL ORDER NO. ________________________________________
A
I
R			CUSTOMER PURCHASE ORDER NO. _________________________________________________
S
T			 NO-PROCEED WITH REPAIRS-INVOICE AGAINST P.O. NO. _________________________________________________
A
T			 NO-CONTACT WITH ESTIMATE OF REPAIR CHARGES: LETTER  __________________________________________
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S
				PHONE		 ___________________________________________
NAME ____________________________________________________					PHONE _________________________________________
ADDRESS ___________________________________________________________________________________________________
______________________________________________________________						ZIP _________________________________________
RETURN AUTHORITY FOR CREDIT ADJUSTMENT [Please check appropriate box(s)]
			 WRONG PART RECEIVED	 REPLACEMENT RECEIVED
			 DUPLICATE SHIPMENT	REFERENCE ROSEMOUNT ANALYTICAL SALES ORDER NO.__________
			 RETURN FOR CREDIT	RETURN AUTHORIZED BY: ______________________________________
			WARRANTY DEFECT____________________________________________________________________________________
			_____________________________________________________________________________________________________
			24-6047
Emerson Process Management

Liquid Division

2400 Barranca Parkway

Irvine, CA 92606 USA

Tel: (949) 757-8500

Fax: (949) 474-7250

http://www.raihome.com

© Rosemount Analytical Inc. 2004