Epson XDT Xentaur Return Authorization Number Request Form, Customer, Information, Equipment

Appendix M: Return Authorization Number Request Form

Xentaur Return Authorization Number Request Form

•Xentaur must approve and assign a Return Authorization Number (RAN) to any instrument being returned.

•The RAN must appear on all paperwork and packaging.

•The issuance of a RAN does not automatically imply that the instrument is covered by our warranty.

•In order to serve you better and protect our employees from any potentially hazardous contaminants Xentaur must return unopened at the senders expense all items that do not have a RAN.

To obtain a RAN fill out this form and fax to (631) 345-5349.

this document may be obtained in electronic format at www.xentaur.com and e-mailed back

Customer Information

Company Name: Contact Name:

Phone:

Fax:

Address:

Equipment Information

	Part or Model Number:	Serial Number:
	Original Purchase Date:	PO Number:
Reason for Return:
Failure and hookup description if applicable:

Use Information

Process material(s) and/or environments (including radiation) to which the equipment has been exposed. An RAN will not be issued without this information.

Certified by: Name:	Title:
Signature:	Date:

OSHA Hazard Communication Standard 29CFR 1910.1200 mandated that we take specific steps to protect our employees from exposure to potential hazards. Therefore, a letter certifying that the equipment has been decontaminated must accompany all equipment exposed to hazardous contamination.

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Xentaur Corporation 84F Horseblock Road, Yaphank, NY, 11980 USA • tel: 631-345-3434 • fax: 631-345-5349