Company Name
Contact Name
Telephone Number
Approximate Usage (hours)
Problems Encountered
Check One: q Repair
Do you wish to be contacted before repairing
q Return
Contact National if a loaner is needed
Return Authorization Number
Customer Number
Purchased From
Date Received
Unit Serial Number
Subject To Warranty
RETURN SHEET
REQUIRED, contact National
if known
if not directly from National
INTERNAL USE ONLY
Page 19
q
q
Yes
No
Date