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Item(s) Being Returned:
Model # ________________________________________________________ Serial # __________________________________________________________________________________________
Description: _________________________________________________________________________________________________________________________________________________________
Reason for return of goods (please list any specific problems) ______________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
Please complete the below, as appropriate.
List all control settings and describe problem: ______________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________ (Attach additional sheets as necessary).
Show a block diagram of your measurement system including all instruments connected (whether power is turned
on or not). Describe signal source. If source is a laser, describe output mode, peak power, pulse width, repetition
rate and energy density.
Name ____________________________________________________________________________________
Company ______________________________________________________________________________
Address ________________________________________________________________________________
Country ________________________________________________________________________________
P.O. Number _________________________________________________________________________
Newport Corporation
U.S.A. Office: 949/863-3144
FAX: 949/253-1800
Where is the measurement being performed?
(factory, controlled laboratory, out-of-doors, etc.) ________________________________________________________________________________________________
What power line voltage is used? ______________________________________________ Variation? __________________________________________________________
Frequency? _____________________________________________________ Ambient Temperature? ________________________________________________________________
Variation? ________________________________________ °F. Rel. Humidity? __________________________________ Other? _________________________________________
Any additional information. (If special modifications have been made by the user, please describe below).
____________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
Service Form
RETURN AUTHORIZATION # ______________________________
(Please obtain prior to return of item)
Date __________________________________________________________________
Phone Number __________________________________________________
FAX Number _____________________________________________________
5.3
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