FS10 Series
Fluid Components International LLC 67
FCI Document No. 05CS000004D [U]
1. Return Customer Information
Returning Company’s Name: _____________________________Phone# __________________________________
Return Contact Name: __________________________________ Fax # ____________________________________
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 (New Data) � Recalibrate (Most Recent Data) � Other
(Note: A new Application Data Sheet (ADS) must be submitted for all recalibrations and re-certifi cations)
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 of $250.00)
Factory Return Shipping Address: Fluid Components International LLC
1755 La Costa Meadows Drive
San Marcos, CA 92078-5115
Attn: Repair Department
RA #____________
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: techsupport@fl uidcomponents.com
Return Authorization Request
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