STEP 1 Company Name: * Will this equipment be exported out of the U.S.A: No Yes Name Required on Data Sheet:
STEP 2 EQUIPMENT RETURN INSTRUCTIONS - Please list ALL model and serial numbers. Please review instrument decal for details required below. If this is a re-range or STP reference change, please indicate previous flow rate, previous pressures (controller only) and previous STP conditions. If this is a Digital instrument with more than one Flow Rate/gas requirement, please list calibration instances. If you have more than 2 units, please make copies of this form.
STEP 3
Has this equipment been used with hazardous material? * NO or YES If yes, please provide complete details
Details: *
I declare that this equipment is clean and is safe to handle.
STEP 4 PAYMENT OPTIONS Purchase Order: All Repaired / Recalibrated or evaluated equipment will be serviced according to Teledyne Hastings Terms and conditions. These terms and conditions are listed at Website http://www.hastings-inst.com/pdfs/Tc-02-23-09.pdf. These Terms and Conditions will be noted as part of our acknowledgement. Any quoted prices are subject to change if requirements differ on the purchase order. Receipt of your equipment for service will indicate your acceptance of Teledyne Hastings Terms and Conditions. All quotes are based on terms of net 30 unless alternate terms have previously been established. Non-repairable equipment that is scrapped (per customer request) or returned “As Is”, is subject to an $95.00 evaluation fee. Credit Card
New Customer If you are a new customer, and you would like to set up an open terms account (domestic only), please e-mail or fax your bank information, 3 trade references, accounting contact, and tax status (exemption certificate if applicable).
STEP 5 Submit or fax the form to us. We will then send you a RMA number, price quote and shipping instructions. kcannon@teledyne.com or csapienzo@teledyne.com Fax: 757- 723-3925
Teledyne Hastings Instruments 804 Newcombe Ave, Hampton, VA 23669 757.723.6531 | http://www.teledyne-hi.com | [F] 757.723.3925 Copyright © 2009 Teledyne Technologies Incorporated. All rights reserved.