48
Service Form Newport Corporation
U.S.A. Office: 714/863-3144
FAX: 714/253-1800
Name _____________________________________________________________________________________ RETURN AUTHORIZATION # _____________________________
Company _______________________________________________________________________________ (Please obtain prior to return of item)
Address _________________________________________________________________________________ Date _________________________________________________________________
_________________________________________________________________________________ Phone Number _________________________________________________
Country _________________________________________________________________________________
P.O. Number ___________________________________________________________________________
Item(s) Being Returned:
Model # ___________________________________________________________________ Serial # ______________________________________________________________________________
Description __________________________________________________________________________________________________________________________________________________________
Reason for return of goods (please list any specific problems) ______________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
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.
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).
____________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________
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