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7560 Paragon Rd. Attn: Ed Kayler Director, Customer Service

Dayton, OH 45459 E-mail: ekayler@rixan.com

Ph: (937) 438-3005

Fax: (937) 438-3545 URL: www.rixan.com



PLEASE FILL OUT...PRINT...AND FAX OR E-MAIL TO ED KAYLER

Robot Repair Request Form

Customer Information



DATE:





COMPANY: CONTACT:

PHONE: FAX:

E-MAIL:





SHIPPING

ADDRESS:

CITY:

STATE: ZIP CODE:





BILLING ADDRESS:

CITY:

STATE: ZIP CODE:





CUSTOMER P.O.

NUMBER





Product & Problem Information



MODEL OF ROBOT:

ARM S/N: CONTROLLER S/N:





DESCRIPTION OF

PROBLEM:









RIXAN SERVICE DEPARTMENT USE ONLY:

Diagnoses:







Remedy:







This form must be completed and faxed or e-mailed to Rixan Associates, Inc. before system is shipped to Rixan’s facility

and evaluated by our Service Department. Please enclose a copy of this form in each robot box sent to Rixan for service.

All non-warranty work will have a $250.00 / $350 .00 charge for evaluation and creation of a repair proposal.

Rixan is not responsible for loss of programs, positions or parameters, Back your system up.

No COD or Freight Collect will be accepted at our dock unless pre-approved by the Director, Customer Service.

*** Insurance will not be added on return shipment UNLESS specified by customer on Purchase Order.



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