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RETURN OF MATERIALS REQUEST
FROM:
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CUSTOMER/USER MUST SUBMIT MATERIAL SAFETY SHEET (MSDS) OR COMPLETE STREAM COMPOSITION, AND/OR
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LETTER CERTIFYING THE MATERIALS HAVE BEEN DISINFECTED AND/OR DETOXIFIED WHEN RETURNING ANY PROD-
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UCT, SAMPLE OR MATERIAL THAT HAVE BEEN EXPOSED TO OR USED IN AN ENVIRONMENT OR PROCESS THAT CON-
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C
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TAINS A HAZARDOUS MATERIAL ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICAL WITHOUT
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THE MSDS WILL BE RETURNED TO SENDER C.O.D. FOR THE SAFETY AND HEALTH OF OUR EMPLOYEES. WE THANK
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YOU IN ADVANCE FOR COMPLIANCE TO THIS SUBJECT.
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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. ________________
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PLEASE CHECK ONE:
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A
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REPAIR AND CALIBRATE
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EVALUATION
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REPLACEMENT REQUIRED?
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DESCRIPTION OF MALFUNCTION:
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______________________________________________________________________________________________________
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______________________________________________________________________________________________________
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______________________________________________________________________________________________________
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WARRANTY REPAIR REQUESTED:
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P
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YES-REFERENCE ORIGINAL ROSEMOUNT ANALYTICAL ORDER NO. ________________________________________
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NO-PROCEED WITH REPAIRS-INVOICE AGAINST P.O. NO. _________________________________________________
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NO-CONTACT WITH ESTIMATE OF REPAIR CHARGES: LETTER
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NAME ____________________________________________________
ADDRESS ___________________________________________________________________________________________________
______________________________________________________________
RETURN AUTHORITY FOR CREDIT ADJUSTMENT [Please check appropriate box(s)]
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WRONG PART RECEIVED
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DUPLICATE SHIPMENT
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RETURN FOR CREDIT
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.RAuniloc.com
© Rosemount Analytical Inc. 2001
RETURN
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_____________________________
_____________________________
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YES
NO
CUSTOMER PURCHASE ORDER NO. _________________________________________________
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REPLACEMENT RECEIVED
REFERENCE ROSEMOUNT ANALYTICAL SALES ORDER NO.__________
RETURN AUTHORIZED BY: ______________________________________
•IMPORTANT!
This form must be completed to ensure expedient factory service.
BILL TO:
_____________________________
_____________________________
_____________________________
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DEMO EQUIPMENT NO. __________________________
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OTHER (EXPLAIN) _______________________________
_________________________________________________
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__________________________________________
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PHONE
___________________________________________
PHONE _________________________________________
ZIP _________________________________________
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