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Bristol Inc. Repair Authorization Form
(Providing this information will permit Bristol Inc. to effectively and efficiently process your return. Completion is required
to receive optimal lead time. Lack of information may result in increased lead times.)
Date___________________
Standard Repair Practice is as follows: Variations to this is
practice may be requested in the "Special Requests" section.
•
Evaluate / Test / Verify Discrepancy
•
Repair / Replace / etc. in accordance with this form
•
Return to Customer
Part I
Please complete the following information for single unit or multiple unit returns
Address No.
Bill to :
Purchase Order:
Phone:
Part II
Model No./Part No.
Range/Calibration
Reason for return :
Failure
1. Describe the conditions of the failure (Frequency/Intermittent, Physical Damage, Environmental Conditions,
Communication, CPU watchdog, etc.)
2. Comm. interface used:
3. What is the Firmware revision? _____________________
Part III If checking "replaced" for any question below, check an alternate option if replacement is not available
A. If product is within the warranty time period but is excluded due
to Bristol's warranty clause, would you like the product:
B. If product were found to exceed the warranty period,
would you like the product:
C. If product is deemed not repairable would you like your product:
D. If Bristol is unable to verify the discrepancy, would you like the product:
* Continue investigating by contacting the customer to learn more about the problem experienced? The person to contact
that has the most knowledge of the problem is:
If we are unable to contact this person the backup person is: _________________________ phone_____________________
Special Requests: ____________________________________________________________________________________
____________________________________________________________________________________________________
Ship prepaid to:
Bristol Inc., Repair Dept., 1100 Buckingham Street, Watertown, CT 06795
Phone: 860-945-2442
RA #___________________SH_
(office use only) Address No.
Fax:
Please complete Parts II & III for each unit returned
Upgrade
Verify Operation
Standalone
RS-485
Ethernet
______________________________ phone_____________________
Fax: 860-945-3875
(off-line completion)
Please be aware of the Non warranty standard charge:
•
There is a $100 minimum evaluation charge, which is
applied to the repair if applicable (√ in "returned"
B,C, or D of part III below)
Ship to:
Contact Name:____________________________________
E-Mail:
Description
S/N
Other
(Attach a separate sheet if necessary)
Modem (PLM (2W or 4W) or SNW)
What is the Software &version?
repaired
returned
repaired
returned
returned
returned
Form GBU 13.01 Rev. B 04/11/06
Line No.____________
(office use only)
______________
Other:
replaced
scrapped?
replaced
scrapped?
replaced
scrapped?
replaced
*see below?
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