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					SERVICE REQUEST 
In order to give you a quick and correct service, please e-mail this sheet to Agilent Technologies.
Please enclose this sheet when sending in the unit.
Order date                                                                                   Your order number / Cost location
INVOICE ADDRESS (if different from delivery address)                                         INVOICE INFORMATION
Company                                                                                                 Warranty (return transport included)
Department                                                                                              Re Repair (return transport included)
Postal address                                                                                          Service agreement; number of agreement
Zip/City                                                                                                To be invoiced
DELIVERY ADDRESS            Please also fill in email

Company                                                                                           Contact person
Department                                                                                        Phone
Street address                                                                                    Fax
Zip/City                                                                                          E-mail
PRODUCT INFORMATION
Model number                                                                                 Serial number
Manufacturer                                                                                 Description
Inventory number                                                                             Accessories/Option
Part of a system Calibration order

PREFERRED SERVICE
Agilent calibration                                                 ISO 17025                                                   Accredited
                                                          (for a selection of instruments)                         (for a selection of instruments)

Interval of Calibration                 month

REPAIR                                                                                Description of fault:
with calibration (recommended)
Calibration must be specified above and will be charged
separately

without calibration

TRANSPORT SERVICES
Customer sends the instrument to address specified at the bottom if nothing else specified.

SPECIAL REQUIREMENTS:




                                         You can also order service and check the status of your service 24 hours a day online
                                                                Infoline: https://www.agilent.com/find/infoline
Please fill in the below sections if you request service for more than one product
PRODUCT INFORMATION
Model number                                                                              Serial number
Manufacturer                                                                              Description
Inventory number                                                                          Accessories/Option
Part of a system Calibration order
PREFERRED SERVICE
Agilent calibration                                              ISO 17025                                                  Accredited
                                                       (for a selection of instruments)                        (for a selection of instruments)
    Interval of Calibration                  month
REPAIR
with calibration (recommended)
Calibration must be specified above and will be charged separately
without calibration

PRODUCT INFORMATION
Model number                                                                              Serial number
Manufacturer                                                                              Description
Inventory number                                                                          Accessories/Option
Part of a system Calibration order
PREFERRED SERVICE
Agilent calibration                                              ISO 17025                                                  Accredited
                                                       (for a selection of instruments)                        (for a selection of instruments)
    Interval of Calibration                  month
REPAIR
with calibration (recommended)
Calibration must be specified above and will be charged separately
without calibration

PRODUCT INFORMATION
Model number                                                                              Serial number
Manufacturer                                                                              Description
Inventory number                                                                          Accessories/Option
Part of a system Calibration order
PREFERRED SERVICE
Agilent calibration                                              ISO 17025                                                  Accredited
                                                       (for a selection of instruments)                        (for a selection of instruments)
 Interval of Calibration                month
REPAIR
with calibration (recommended)
Calibration must be specified above and will be charged separately
without calibration



Deliver-to-address:                                                                                                        Phone:
UPS-SCS                                                                                                                       +45 45 80 12 15
C/O Agilent Technologies                                                                                                      E-mail
Rugvaenget 35                                                                                                                    kunde.service@altoo,dk
2630 Taastrup
Denmark




                                         You can also order service and check the status of your service 24 hours a day online
                                                             Infoline: https://www.agilent.com/find/infoline

				
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posted:4/30/2013
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