MSA EVOLUTION 5200 - Application Instructions and Requirements; Camera Information for Service; Extended Service Application Form

15
Evolution
®
Thermal Imaging Camera
Extended Service Application
Submit this completed form to:
MSA
Attention: Fire Service Customer Service Center
Evolution TIC Extended Service Program
PO Box 426
Pittsburgh, PA 15230-0426
(or Fax 1-412-967-3053)
One application must be submitted for EACH Evolution TIC. Phone 1-800-MSA-2222 for assistance in completing this form.
1. Extended warranty requests MUST be exercised within the first 6 months from the date of manufacture. The last three characters
(MYY, or “month-year-year”) of the TIC’s serial number (located in the battery compartment of the TIC) will dictate this time-frame
(XX-XXXX-MYY).
2. Extended warranty will lengthen warranty coverage up to 12 months after the standard warranty would expire.
(Total coverage for the camera core would be 36 months; total coverage for the rest of the camera would be 24 months.)
3. Extended warranty and standard warranty both begin from the date of purchase by the end user.
4. This Extended Warranty program applies only to MSA Evolution Thermal Imaging Cameras. Consumables, battery chargers
and accessories are not covered.
Please print legibly
Company/Department Name
Contact Name Title
Phone Fax Email
MAILING ADDRESS:
Street/PO Box
City
State/Province Zip/PC
SHIPPING ADDRESS:
Street/PO Box
City
State/Province Zip/PC
Please extend the service on the following MSA Evolution Thermal Imaging Camera:
Evolution 5200 TIC Evolution 5200HD2/ThermalTrac TIC Evolution 5600 TIC Evolution 5800
Serial # (located in TIC battery compartment)
This TIC was purchased from (insert MSA distributor company name) on our
Purchase Order # dated Distributor Invoice # dated
Purchase Order # enclosed
Print Name
Authorized Signature
1 year extended service - US $1000