Condec DPDG - Manual (Page 18)

Pressure Products
Return Authorization Form
NAME OF PERSON TO CONTACT ABOUT THIS REPAIR: _____________________________________
ITEM (1): ❏ Estimate Required ❏ Warranty ❏ Repair ❏ Calibration ❏ Calibration w/data
Please note maximum repair cost: $ ____________
Description: ___________________________ Part #: ______________Serial #: ____________
Purchase Order #:_______________________________________________________________
Problem (please be specific): _____________________________________________________
________________________________________________________________________________
ITEM (2): ❏ Estimate Required ❏ Warranty ❏ Repair ❏ Calibration ❏ Calibration w/data
Please note maximum repair cost: $ ____________
Description: ___________________________ Part #: ______________Serial #: ____________
Purchase Order #:_______________________________________________________________
Problem (please be specific): _____________________________________________________
________________________________________________________________________________
ITEM (3): ❏ Estimate Required ❏ Warranty ❏ Repair ❏ Calibration ❏ Calibration w/data
Please note maximum repair cost: $ ____________
Description: ___________________________ Part #: ______________Serial #: ____________
Purchase Order #:_______________________________________________________________
Problem (please be specific): _____________________________________________________
________________________________________________________________________________
ITEM (4): ❏ Estimate Required ❏ Warranty ❏ Repair ❏ Calibration ❏ Calibration w/data
Please note maximum repair cost: $ ____________
Description: ___________________________ Part #: ______________Serial #: ____________
Purchase Order #:_______________________________________________________________
Problem (please be specific): _____________________________________________________
________________________________________________________________________________
INTERNAL USE ONLY
SO #__________________________________
888-295-8475 • Fax: 203-364-1556
VITAL INFORMATION (To Help Us Serve You):
DATE: _________________________________
YOUR NAME: ____________________________
COMPANY: ______________________________
CUSTOMER NO: _________________________
PURCHASE ORDER NO: ____________________
PHONE NUMBER: ( ) ___________________
FAX NUMBER: ( ) ______________________
BILL TO ADDRESS:
ADDRESS: ______________________________
CITY:___________________________________
STATE: ____________ZIP:__________________
SHIP TO (If Different):
COMPANY NAME: ________________________
ADDRESS: ______________________________
CITY:___________________________________
STATE: ____________ ZIP: _________________