CUSTOMER REPAIR REPORT
FOR SERVICE, COMPLETE THIS FORM, AND RETURN IT ALONG WITH THE AFFECTED EQUIPMENT
TO CUSTOMER SERVICE AT THE ADDRESS INDICATED BELOW.
COMPANY NAME:____________________________________________________________________________
TECHNICAL CONTACT:_____________________________________ PHONE: __________________________
REPAIR P. O. #:________________________ IF WARRANTY, UNIT S/N:________________________________
INVOICE ADDRESS:___________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
SHIPPING ADDRESS:______________ ___ _________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
RETURN SHIPPING METHOD: __________________________________________________________________
EQUIPMENT MODEL #:____________________ S/N:__________________FAILURE DATE:_______________
DESCRIPTION OF PROBLEM:___________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
WHAT WAS HAPPENING AT TIME OF FAILURE?__________________________________________________
_____________________________________________________________________________________________
ADDITIONAL COMMENTS: ____________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
REPORT PREPARED BY:__________________________________ TITLE:______________________________
IF YOU REQUIRE TECHNICAL ASSISTANCE, PLEASE FAX OR WRITE THE CUSTOMER SERVICE
DEPARTMENT AT:
DANIEL MEASUREMENT SERVICES
DIVISION OF EMERSON PROCESS MANAGEMENT PHONE: (713) 827-6380
ATTN: CUSTOMER SERVICE FAX: (713) 827-6312
11100 BRITTMOORE PARK DRIVE
HOUSTON, TEXAS 77041
FOR FASTEST SERVICE CONTACT DANIEL MEASUREMENT SERVICES VIA OUR WEBSITE:
www.emersonprocess.com/daniel