Print, Complete and Return this form with your instrument

Contact Name:

______________________________________________________
Company Name: ______________________________________________________
Telephone:

_________________________ Fax: ________________________

Email Address: ______________________________________________________
   
Billing Address:     Shipping Address:
____________________________________________   ____________________________________________
____________________________________________   ____________________________________________
____________________________________________   ____________________________________________
____________________________________________   ____________________________________________
Reason for return: ____ Repair ____ Re-certification Other ________________________________
Instrument Model: ______________________ Serial Number (S/N): _______________________

Detailed Symptoms or problems you are experiencing (Very Important):

____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Calibration and repair work is performed at our manufacturing location. Our address is:

DeFelsko Corporation
Attn: Service Department
802 Proctor Avenue
Ogdensburg, NY 13669 USA

Important note to our International Customers (Outside USA):

Include a Commercial Invoice showing the description of the instruments, and Value for Customs Purposes Only. Include the following statement:

"U.S. Goods Returned For Repair/Calibration. Country of Origin: USA"

NOTE: Failure to include this statement in your invoice will result in U.S. Customs assessing duties on the shipment, which we will in turn pass on to the customer/shipper.