4
SS2123 Rev A 05/16/04
ISO
✓
Certified
9001:
2000
159 Swanson Road, Boxborough, MA 01719-1304/Tel: 800-257-3872/978-263-1400/
Fax 978-264-0292/Email: sales@setra.com, Web: www.setra.com
Setra Systems, Inc.
159 Swanson road
Boxborough, MA 01719
Repair Dept. Fax #: 978-266-2158/Phone #: 978-266-2194
✮ All lines must be filled out.
✮ This form must accompany all returns. Returns that arrive with no information will be rejected.
CONTACT NAME: _______________________ EMAIL ADDRESS: __________________________
COMPANY: __________________________ DATE: ________________________________
PHONE NUMBER:_______________________ FAX NUMBER: ___________________________
PURCHASE ORDER WITH “NOT TO EXCEED” AMOUNT CREDIT CARD #, EXP. DATE / CARDHOLDER NAME:
MODEL / PART # AND QTY: SERIAL NUMBER/S:
EXPEDITE , 1-3 days ($50 FEE) RUSH, 5-7 days STD TIME, 2-3 weeks
CALIBRATION ONLY CERT NEEDED FAILURE ANALYSIS
REASON FOR RETURN/DESCRIPTION OF PROBLEM:
NOTES/COMMENTS OR SPECIAL HANDLING
Any product that has been used with Hazardous Materials must be 100% purged and should be accompanied by a MSDS sheet,
bagged, sealed, and tagged accordingly. Setra will not accept delivery of any product exposed to chemicals,
radioactive agents, or biological process without evidence of decontamination or laboratory analysis, and
proof the biological process is not harmful.
Hazardous chemicals: Yes No (circle one)
List of Chemicals used: _________________________________________________________
Has unit been purged? Yes __ No __ Purged with what? ____________________
Has unit been flushed? Yes __ No __ Flushed with what? ____________________
Has unit been decontaminated: Yes __ No __ Explain Process: ______________________
All wetted surfaces have been removed: Yes __ No __
Billing Address: Shipping Address
Method of Shipment:
(circle one) PPD: Yes Collect: Yes Please list account #
SERVICE/REPAIR/CALIBRATION ORDER RETURN FORM
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