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Service info
Customer data: Date:
Customer name and address:___________________________________________
Attention and Dept.:___________________________________________________
Fax no./Phone no.:____________________________________________________
Your order no.:_______________________________________________________
Delivery address:_____________________________________________________
Distributor name:_____________________________________________________
Instrument data:
Model and Serial no.:__________________________________________________
Warranty claimed Yes:____ No:_____ Original invoice no.:_________________
___________________________________________________________________
Temp. Sensor Service request: This instrument is sent for
calibration input (please tick off):
___ Calibration as left ___ Check
___ Calibration as found and as left ___ Service
___ Accredited calibration as left ___ Repair
___ Accredited calibration as found and as left.
___________________________________________________________________
Diagnosis data/cause for return:
Diagnosis/Fault description:_____________________________________________
___________________________________________________________________
Special requests:_____________________________________________________
___________________________________________________________________
Safety precautions: if the product has been exposed to any hazardous substances, it must be
thoroughly decontaminated before it is returned to Ametek. Details of the hazardous substances
and any precautions to be taken must be enclosed.
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