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CUSTOMER REPAIR REPORT
FOR SERVICE, COMPLETE THIS FORM, AND RETURN IT ALONG WITH THE AFFECTED EQUIPMENT
TO CUSTOMER SERVICE AT THE ADDRESS INDICATED BELOW.
COMPANY NAME: ___________________________________________________________________________
TECHNICAL CONTACT:_____________________________________ PHONE: _________________________
REPAIR P. O. #:________________________ IF WARRANTY, UNIT S/N:_____________________________
INVOICE ADDRESS: __________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
SHIPPING ADDRESS: _________________________________________________________________________
_____________________________________________________________________________________________
RETURN SHIPPING METHOD: _________________________________________________________________
EQUIPMENT MODEL #:____________________ S/N:__________________FAILURE DATE: _____________
DESCRIPTION OF PROBLEM: __________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
WHAT WAS HAPPENING AT TIME OF FAILURE? _______________________________________________
_____________________________________________________________________________________________
ADDITIONAL COMMENTS:____________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
REPORT PREPARED BY:__________________________________ TITLE: _____________________________
IF YOU REQUIRE TECHNICAL ASSISTANCE, PLEASE FAX OR WRITE THE CUSTOMER SERVICE
DEPARTMENT AT:
DANIEL MEASUREMENT SERVICES
DIVISION OF EMERSON PROCESS MANAGEMENT PHONE: (713) 827-6314
ATTN: CUSTOMER SERVICE FAX: (713) 827-6312
11100 BRITTMOORE PARK DRIVE
HOUSTON, TEXAS 77041
FOR FASTEST SERVICE CONTACT DANIEL MEASUREMENT SERVICES VIA OUR WEBSITE:
www.emersonprocess.com/daniel