Fluid Components International FR73B Complete Manual - Manual (Page 18)

FLUID COMPONENTS INTERNATIONAL LLC FR78B Flow Switch/Monitor
This page is subject to proprietary rights statement on last page 18 Doc. No. 06EN003281 Rev. A
RA #___________
1755 La Costa Meadows Drive, San Marcos, CA 92078-5115 USA
760-744-6950 / 800-854-1993 / Fax: 760-736-6250
Web Site: www.fluidcomponents.com / E-mail: [email protected]
FCI Document No. 05CS000004B
Return Authorization Request
1. Return Customer Information
Returning Company’s Name:__________________________________ Fax # __________________
Return Contact Name: ______________________________________ Phone # ________________
Email Address: _______________________________________________________________________
2. Return Address
Bill To: _________________________________ Ship To: __________________________________
_______________________________________ _________________________________________
_______________________________________ _________________________________________
_______________________________________ _________________________________________
3. Mandatory End User Information
Contact: __________________ Company: ________________________ Country: _____________
4. Return Product Information
Model No: ______________________________ Serial No(s): ______________________________
Failure Symptoms (Detailed Description Required): ________________________________________
___________________________________________________________________________________
What Trouble Shooting Was Done Via Phone or Field Visit by FCI: ____________________________
___________________________________________________________________________________
FCI Factory Technical Service Contact: __________________________________________________
5. Reason For Return Sensor Element Electronics As Found Testing Credit
Recalibrate (Old Data) Recalibrate (New Data) Other
(Note: A new Application Data Sheet (ADS) must be submitted for all recalibrations and re-certifications)
6. Payment Via Faxed Purchase Order
(Note: A priced quotation is provided for all Non-Warranty repairs after equipment has been evaluated. All
Non-Warranty repairs are subject to a minimum evaluation charge)
Decontamination Information ! This Section Must Be Completed !
Exposure to hazardous materials is regulated by Federal, State (California), County and City laws and regulations. These laws
provide FCI’s employees with the “Right to Know” the hazardous or toxic materials or substances in which they may come in contact
while handling returned products. Consequently, our employees must have access to data regarding the hazardous or toxic materi-
als or substances which the equipment has been exposed to in your process(es). Accordingly, prior to returning your instrument for
evaluation/repair, please read then sign the certification below and thoroughly comply with the applicable instructions.
I certify that the returned item(s) has(have) been thoroughly and completely cleaned. If the returned item(s) has(have) been exposed
to hazardous or toxic materials or substances, the undersigned attests that the attached Material Safety Data Sheet(s) (MSDS) which
cover said materials or substances are complete and accompany the returned item(s). Furthermore, I understand that this Certifi-
cate, or providing a MSDS, shall not waive our responsibility to provide a neutralized, decontaminated, and clean product for
evaluation/repair to FCI. Cleanliness of a returned item or the acceptability of the MSDS shall be at the sole discretion of FCI. Any
item returned which does not comply with these instructions shall be returned to your location Freight Collect and at your risk.
Process Flow Media _______________________________________________________________________________________________
Authorized Signature _____________________________________ Date ___________________________________________________