Emerson Process Management TF396 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	_____________________________		_____________________________			_____________________________
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T
O	_____________________________		_____________________________			_____________________________
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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-
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	N
C	D	TAINS A HAZARDOUS MATERIAL ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICAL WITHOUT
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	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		n REPAIR AND CALIBRATE		n DEMO EQUIPMENT NO. __________________________
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O		n EVALUATION		n OTHER (EXPLAIN) _______________________________
N
F		n REPLACEMENT REQUIRED? n YES n NO		_________________________________________________
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R		DESCRIPTION OF MALFUNCTION:
R		______________________________________________________________________________________________________
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U		______________________________________________________________________________________________________
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N
		______________________________________________________________________________________________________
R		WARRANTY REPAIR REQUESTED:
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P		n YES-REFERENCE ORIGINAL ROSEMOUNT ANALYTICAL ORDER NO. ________________________________________
A
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R		CUSTOMER PURCHASE ORDER NO. _________________________________________________
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T		n NO-PROCEED WITH REPAIRS-INVOICE AGAINST P.O. NO. _________________________________________________
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T		n NO-CONTACT WITH ESTIMATE OF REPAIR CHARGES: LETTER n __________________________________________
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S
			PHONE		n ___________________________________________
NAME ____________________________________________________				PHONE _________________________________________
ADDRESS ___________________________________________________________________________________________________
______________________________________________________________					ZIP _________________________________________
RETURN AUTHORITY FOR CREDIT ADJUSTMENT [Please check appropriate box(s)]
		n WRONG PART RECEIVED	n REPLACEMENT RECEIVED
		n DUPLICATE SHIPMENT	REFERENCE ROSEMOUNT ANALYTICAL SALES ORDER NO.__________
		n 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. 2008