RETURN OF MATERIALS REQUEST

•IMPORTANT!

This form must be completed to ensure expedient factory service.

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FROM:

RETURN

 

 

BILL TO:

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CUSTOMER/USER MUST SUBMIT MATERIAL SAFETY SHEET (MSDS) OR COMPLETE STREAM COMPOSITION, AND/OR

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S LETTER CERTIFYING THE MATERIALS HAVE BEEN DISINFECTED AND/OR DETOXIFIED WHEN RETURNING ANY PROD-

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UCT, SAMPLE OR MATERIAL THAT HAVE BEEN EXPOSED TO OR USED IN AN ENVIRONMENT OR PROCESS THAT CON-

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TAINS A HAZARDOUS MATERIAL ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICAL WITHOUT

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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.

 

 

 

 

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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. ________________

 

 

 

 

 

 

 

 

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PLEASE CHECK ONE:

 

 

 

 

 

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 REPAIR AND CALIBRATE

 DEMO EQUIPMENT NO. __________________________

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 EVALUATION

 OTHER (EXPLAIN) _______________________________

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 REPLACEMENT REQUIRED?  YES  NO

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DESCRIPTION OF MALFUNCTION:

 

 

 

 

 

 

 

 

 

 

 

 

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WARRANTY REPAIR REQUESTED:

 

 

 

 

 

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 YES-REFERENCE ORIGINAL ROSEMOUNT ANALYTICAL ORDER NO. ________________________________________

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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

 ___________________________________________

 

 

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.RAuniloc.com

© Rosemount Analytical Inc. 2001

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Emerson 381 instruction manual Return of Materials Request