FROM: RETURN BILLTO:
_____________________________ _____________________________ _____________________________
_____________________________ _____________________________ _____________________________
_____________________________ _____________________________ _____________________________
CUSTOMER/USER MUST SUBMIT MATERIALSAFETY SHEET (MSDS) OR COMPLETE STREAM COMPOSITION, AND/OR
LETTER CERTIFYING THE MATERIALS HAVE BEEN DISINFECTED AND/OR DETOXIFIED WHEN RETURNING ANYPROD-
UCT, SAMPLE OR MATERIALTHATHAVE BEEN EXPOSED TO OR USED IN AN ENVIRONMENTOR PROCESS THAT CON-
TAINS AHAZARDOUS MATERIAL ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICALWITHOUT
THE MSDS WILLBE 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:

REPAIR AND CALIBRATE DEMO EQUIPMENT NO. __________________________

EVALUATION OTHER (EXPLAIN) _______________________________

REPLACEMENTREQUIRED? YES NO _________________________________________________

DESCRIPTION OF MALFUNCTION:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
WARRANTYREPAIR REQUESTED:

YES-REFERENCE ORIGINALROSEMOUNT ANALYTICAL ORDER NO. ________________________________________

CUSTOMER PURCHASE ORDER NO. _________________________________________________

NO-PROCEED WITH REPAIRS-INVOICE AGAINSTP.O. NO. _________________________________________________

NO-CONTACTWITH ESTIMATE OF REPAIR CHARGES: LETTER __________________________________________

PHONE ___________________________________________
NAME ____________________________________________________ PHONE_________________________________________
ADDRESS___________________________________________________________________________________________________
______________________________________________________________ ZIP _________________________________________
RETURN AUTHORITYFOR CREDIT ADJUSTMENT [Please check appropriate box(s)]

WRONG PARTRECEIVED REPLACEMENTRECEIVED

DUPLICATE SHIPMENT REFERENCE ROSEMOUNTANALYTICAL SALES ORDER NO.__________

RETURN FOR CREDIT RETURN AUTHORIZED BY:______________________________________

WARRANTYDEFECT____________________________________________________________________________________
_____________________________________________________________________________________________________
24-6047
RETURN OF MATERIALS REQUEST •IMPORTANT!
This form must be completed to ensure expedient factory service.
R
E
P
A
I
R
S
T
A
T
U
S
R
E
A
S
O
N
F
O
R
R
E
T
U
R
N
C
U
S
T
O
M
E
R
N
O
T
I
C
E
T
O
S
E
N
D
E
R
Emerson Process Management
Rosemount Analytical Inc.
2400 Barranca Parkway
Irvine, CA92606 USA
Tel: (949) 757-8500
Fax: (949) 474-7250
http://www.raihome.com
© Rosemount Analytical Inc. 2001