FROM: RETURN BILL TO:
_____________________________ _____________________________ _____________________________
_____________________________ _____________________________ _____________________________
_____________________________ _____________________________ _____________________________
CUSTOMER/USER MUST SUBMIT MATERIAL SAFETY SHEET (MSDS) OR COMPLETE STREAM COMPOSITION, AND/OR
LETTER CERTIFYING THE MATERIALS HAVE BEEN DISINFECTED AND/OR DETOXIFIED WHEN RETURNING ANY PROD-
UCT, SAMPLE OR MATERIAL THAT HAVE BEEN EXPOSED TO OR USED IN AN ENVIRONMENT OR PROCESS THAT CON-
TAINS A HAZARDOUS MATERIAL ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICAL WITHOUT
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.
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:

nnREPAIR AND CALIBRATE nnDEMO EQUIPMENT NO. __________________________

nnEVALUATION nnOTHER (EXPLAIN) _______________________________

nnREPLACEMENT REQUIRED? nnYES nnNO _________________________________________________

DESCRIPTION OF MALFUNCTION:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
WARRANTY REPAIR REQUESTED:

nnYES-REFERENCE ORIGINAL ROSEMOUNT ANALYTICAL ORDER NO.________________________________________

CUSTOMER PURCHASE ORDER NO. _________________________________________________

nnNO-PROCEED WITH REPAIRS-INVOICE AGAINST P.O. NO._________________________________________________

nnNO-CONTACT WITH ESTIMATE OF REPAIR CHARGES: LETTER nn__________________________________________

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

nnWRONG PART RECEIVED nnREPLACEMENT RECEIVED

nnDUPLICATE SHIPMENT REFERENCE ROSEMOUNT ANALYTICAL SALES ORDER NO.__________

nnRETURN FOR CREDIT RETURN AUTHORIZED BY:______________________________________

WARRANTY DEFECT____________________________________________________________________________________
_____________________________________________________________________________________________________
24-6047
RETURN OF MATERIALS REQUEST •IMPORTANT!
This form must be completed to ensure expedient factory service.
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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