DANIEL INDUSTRIES, INC.
CUSTOMER PROBLEM REPORT
FOR FASTEST SERVICE, COMPLETE THIS FORM, AND RETURN IT ALONG WITH THE AFFECTED
EQUIPMENT TO CUSTOMER SERVICE AT THE ADDRESS INDICATED BELOW.
COMPANY NAME:____________________________________________________________________________
TECHNICAL CONTACT:_________________________________ PHONE:______________________________
REPAIR P. O. #:_____________________________ IF WARRANTY, UNIT S/N:_________________________
INVOICE ADDRESS:____________________________________________________________________
_________________________________________________________________
_________________________________________________________________
SHIPPING ADDRESS:___________________________________________________________________
_________________________________________________________________
_________________________________________________________________
RETURN SHIPPING METHOD:__________________________________________________________________
EQUIPMENT MODEL #:____________________ S/N:__________________FAILURE DATE:_____________
DESCRIPTION OF PROBLEM:__________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
WHAT WAS HAPPENING AT TIME OF FAILURE?________________________________________________
______________________________________________________________________________________________
ADDITIONAL COMMENTS:____________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
REPORT PREPARED BY:________________________________ TITLE:________________________________
IF YOU REQUIRE TECHNICAL ASSISTANCE, PLEASE FAX OR WRITE THE MAIN CUSTOMER SERVICE
DEPARTMENT AT:
DANIEL MEASUREMENT AND CONTROL PHONE: (281) 897-2900
ATTN: CUSTOMER SERVICE FAX: (281) 897-2901
19203 HEMPSTEAD HIGHWAY
HOUSTON, TEXAS 77065
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