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FROM: RETURN BILL TO:
_____________________________ _____________________________ _____________________________
_____________________________ _____________________________ _____________________________
_____________________________ _____________________________ _____________________________
CUSTOMER/USER MUST SUBMIT MATERIAL SAFETY SHEET (MSDS) OR COMPLETE STREAM COMPOSITION, AND/OR
LETTER CERTIFYING THE MATERIALS HAVE BEEN DISINFECTED AND/OR DETOXIFIED WHEN RETURNING ANY
PRODUCT, SAMPLE OR MATERIAL THAT HAVE BEEN EXPOSED TO OR USED IN AN ENVIRONMENT OR PROCESS THAT
CONTAINS A HAZARDOUS MATERIAL ANY OF THE ABOVE THAT IS SUBMITTED TO ROSEMOUNT ANALYTICAL WITH-
OUT THE MSDS WILL BE RETURNED TO SENDER C.O.D. FOR THE SAFETY AND HEALTH OF OUR EMPLOYEES. WE
THANK YOU IN ADVANCE FOR COMPLIANCE TO THIS SUBJECT.
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.________________
PLEASE CHECK ONE:
n REPAIR AND CALIBRATE n DEMO EQUIPMENT NO. __________________________
n EVALUATION n OTHER (EXPLAIN) _______________________________
n REPLACEMENT REQUIRED? n YES n NO _________________________________________________
DESCRIPTION OF MALFUNCTION:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
WARRANTY REPAIR REQUESTED:
n YES-REFERENCE ORIGINAL ROSEMOUNT ANALYTICAL ORDER NO. ________________________________________
CUSTOMER PURCHASE ORDER NO. _________________________________________________
n NO-PROCEED WITH REPAIRS-INVOICE AGAINST P.O. NO. _________________________________________________
n NO-CONTACT WITH ESTIMATE OF REPAIR CHARGES: LETTER n __________________________________________
PHONE n
___________________________________________
NAME ____________________________________________________ PHONE _________________________________________
ADDRESS ___________________________________________________________________________________________________
______________________________________________________________ ZIP _________________________________________
RETURN AUTHORITY FOR CREDIT ADJUSTMENT [Please check appropriate box(s)]
n WRONG PART RECEIVED n REPLACEMENT RECEIVED
n DUPLICATE SHIPMENT REFERENCE ROSEMOUNT ANALYTICAL SALES ORDER NO. _________
n RETURN FOR CREDIT RETURN AUTHORIZED BY: ______________________________________
WARRANTY DEFECT____________________________________________________________________________________
_____________________________________________________________________________________________________
24-6047
RETURN OF MATERIALS REQUEST
•IMPORTANT!
This form must be completed to ensure expedient factory service.
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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