H2Scan Product Applications

Customer Application Information Form

This information is required to properly configure an analyzer based on your specific specifications.

1.0: Customer Information

Name

First Last

This field is hidden when viewing the form

Date

Title

Company

Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

2.0: Product Information

Model Number

Serial Number

Date installed (if known)

For 27XX-series models only : Installed with paired pressure transducer?

If “YES”, the paired pressure transducer MUST be returned with the analyzer. The pressure transducer is REQUIRED for correct paired calibration with the analyzer. Failure to return it may delay service and/or result in a sub-optimal calibration.

Yes

No

3.0: Description of Problem

Reason for Return

Description of the problem

List any error codes if known

Describe any troubleshooting steps attempted

Additional Comments

4.0: Material Disposition

If unit cannot be repaired, it should be:

Returned as is

Discarded

H2scan reserves the right to discard units after 30 days if no instructions are provided.

5.0: Customer Acknowledgement

Customer hereby states that the unit has not been exposed to radioactive or hazardous materials. H2scan is not able to accept such returns
Customer agrees that units sent for service may not be repairable or may be deemed beyond economic repair.
Prior to returning an analyzer to service it is strongly recommended to perform a field calibration. Refer to the product manuals for proper installation and operation. The latest versions can always be found at www.h2scan.com.

PLEASE CHECK THIS BOX TO ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTOOD THE ABOVE INFORMATION. RETURNS CANNOT BE PROCESSED AND MAY BE DELAYED IF THIS BOX IS NOT CHECKED.

Customer Acknowledgement

I agree

RMA Form

Customer Application Information Form