Newport CONEX - AGAP - Service Form

CONEX-AGAP Agilis-D Controller with Strain Gages Feedback
Service Form
Your Local Representative
Tel.: ___________________
Fax: ___________________
Name: __________________________________________________ Return authorization #: _____________________________________
Company: _______________________________________________
(Please obtain prior to return of item)
Address:_________________________________________________ Date: ___________________________________________________
Country:_________________________________________________ Phone Number: ___________________________________________
P.O. Number: ____________________________________________ Fax Number: _____________________________________________
Item(s) Being Returned: ____________________________________
Model#: _________________________________________________ Serial #: _________________________________________________
Description:__________________________________________________________________________________________________________
Reasons of return of goods (please list any specific problems):__________________________________________________________________
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