Service Form
Model No. _______________ Serial No. __________________ Date _________________
Name and Telephone No. ___________________________________________________
Company _______________________________________________________________________
List all control settings, describe problem and check boxes that apply to problem. _________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
❑ Intermittent ❑ Analog output follows display ❑ Particular range or function bad; specify
_______________________________
❑ IEEE failure ❑ Obvious problem on power-up ❑ Batteries and fuses are OK
❑ Front panel operational ❑ All ranges or functions are bad ❑ Checked all cables
Display or output (check one)
❑ Drifts ❑ Unable to zero ❑ Unstable
❑ Overload ❑ Will not read applied input
❑ Calibration only ❑ Certificate of calibration required ❑ Data required
(attach any additional sheets as necessary)
Show a block diagram of your measurement including all instruments connected (whether power is turned on or
not). Also, describe signal source.
Where is the measurement being performed? (factory, controlled laboratory, out-of-doors, etc.) ______________
__________________________________________________________________________________________
What power line voltage is used?___________________ Ambient temperature? ________________________°F
Relative humidity? ___________________________________________Other? __________________________
Any additional information. (If special modifications have been made by the user, please describe.)
__________________________________________________________________________________________
__________________________________________________________________________________________
Be sure to include your name and phone number on this service form.
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