Newport XPS-D - Service Form

XPS-D Controller User Interface Manual
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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41 EDH0405En1012 – 09/18