Brookfield DV-III Rheometer - Manual (Page 82)

Brookfield Engineering Laboratories, Inc. Page 82 Manual No. M/98-211-A0701
Providing us with the following information will help us to service your equipment more quickly and
efficiently. Please photocopy, fill out and return a copy of this form with your instrument.
Brookfield recommends that all viscometers be returned for annual calibration to ensure that your
equipment continues to provide the same accuracy you have come to expect from Brookfield products.
COMPANY INFORMATION
3 SERVICE INFORMATION
Operating Conditions (Spindle; Speed; Viscosity Range; Temp. Control; Temperature of Sample) :
_________________________________________________________________________
_________________________________________________________________________
Did you contacting Brookfield before returning this instrument? Y ❏ N ❏
If yes, whom did you contact? ________________________________________________
Description/Symptoms of Present Problem/Malfunction
(please list all) :
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Time Since Last Serviced ( if known ) : ______ Before & After Calibration Check? Y ❏ N ❏
Other Comments: _________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
1
2
VISCOMETER INFORMATION
Date: _______________________
Serial Number: _______________________ Model: _____________________
Company: _________________________ Primary User: ________________________
Telephone: ________________________ Fax: ________________________________
P.O. Number: ______________________ (to cover repair and shipping)
Billing Address: ____________________ Shipping Address: _____________________
_________________________________ ___________________________________
_________________________________ ___________________________________
_________________________________ ___________________________________
Return Shipment Instructions: UPS ground ❏ UPS Next Day ❏ UPS 2nd Day ❏
Federal Express ❏ _______________________________
(Federal Express Account Number required)
STEPS:
❏ Return the Viscometer to the attention of the Repair Department at the address above.
❏
Package the Viscometer for shipment, as outlined on the previous page.
❏
Include a purchase order or purchase order number with this form.