Setra System Model 217 - Manual (Page 8)

8
159 Swanson Road, Boxborough, MA 01719-1304/Tel: 800-257-3872/978-263-1400,
Fax 978-264-0292/Email: [email protected]/ Web: www.setra.com
Setra Systems, Inc.
159 Swanson road
Boxborough, MA 01719
Repair Dept. Fax #: 978-266-2158/Phone #: 978-266-2194
✮ All lines must be filled out.
✮
This form must accompany all returns. Returns that arrive with no information will be rejected.
CONTACT NAME: ________________________ EMAIL ADDRESS: __________________________
COMPANY: ____________________________ DATE: ________________________________
PHONE NUMBER: ________________________ FAX NUMBER: ____________________________
PURCHASE ORDER WITH “NOT TO EXCEED” AMOUNT CREDIT CARD #, EXP. DATE / CARDHOLDER NAME:
MODEL / PART # AND QTY: SERIAL NUMBER/S:
oEXPEDITE , 1-3 days ($50 FEE) oRUSH, 5-7 days oSTD TIME, 2-3 weeks
oCALIBRATION ONLY oCERT NEEDED oFAILURE ANALYSIS
REASON FOR RETURN/DESCRIPTION OF PROBLEM:
NOTES/COMMENTS OR SPECIAL HANDLING
Any product that has been used with Hazardous Materials must be 100% purged and should be accompanied by a MSDS sheet,
bagged, sealed, and tagged accordingly. Setra will not accept delivery of any product exposed to chemicals, radioactive agents, or
biological process without evidence of decontamination or laboratory analysis, and proof the biological process is not harmful.
Hazardous chemicals:
Yes No (circle one)
List of Chemicals used: __________________________________________________________
Has unit been purged?
Yes __ No ___ Purged with what? ____________________
Has unit been flushed? Yes __ No ___ Flushed with what? ____________________
Has unit been decontaminated? Yes __ No ___ Explain Process: ______________________
All wetted surfaces have been removed: Yes No
Billing Address: Shipping Address
Method of Shipment:
PPD: Yes
Collect: Yes Please list account #
SS2035 R
ev.E 02.24.11
SERVICE/REPAIR/CALIBRATION ORDER RETURN FORM