Emerson Combination pH/ORP Sensor Return of Materials Request, Sensor or Circuit Board only

RETURN OF MATERIALS REQUEST

•IMPORTANT!

This form must be completed to ensure expedient factory service.

C		FROM:	RETURN			BILL TO:
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:
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A		 REPAIR AND CALIBRATE		 DEMO EQUIPMENT NO. __________________________
S
O		 EVALUATION		 OTHER (EXPLAIN) _______________________________
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F		 REPLACEMENT REQUIRED?  YES  NO		_________________________________________________
O
R		DESCRIPTION OF MALFUNCTION:
R		______________________________________________________________________________________________________
E
T
U		______________________________________________________________________________________________________
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N
		______________________________________________________________________________________________________
R		WARRANTY REPAIR REQUESTED:
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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

Rosemount Analytical Inc.

2400 Barranca Parkway

Irvine, CA 92606 USA

Tel: (949) 757-8500

Fax: (949) 474-7250

http://www.raihome.com

© Rosemount Analytical Inc. 2005