Service Form - HELIX GRANVILLE-PHILLIPS Convectron ATM Instruction Manual

RA number ____________________________________ Model number _________________________________
Serial number _________________________________________________________ Date _________________
Name ________________________________________ Phone number _________________________________
Company _____________________________________________________________________________________
Street address __________________________________________________________________________________
City __________________________________________ State _________________ ZIP __________________
Please help Helix Technology provide the best possible service by giving us information that will help us
determine the cause of the problem and protect our analysis and calibration equipment from contamination.
Problem description: ____________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Application description: _________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Has this product been used with
high vapor pressure or hazardous materials?
If Yes, please list the types of gas, chemicals (common names, specific chemical,) biological materials, or other
potentially contaminating or harmful materials exposed to the product during its use.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
PRODUCTS EXPOSED TO RADIOACTIVE MATERIAL CANNOT BE ACCEPTED
Corporate officer signature _______________________________________________________________________
Contact name __________________________________ Phone number _________________________________
®
Convectron ATM Vacuum Gauge Module Instruction Manual

Service Form

BY HELIX TECHNOLOGY UNDER ANY CIRCUMSTANCES.
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