1a - Contact Information
* Full Name
* Email Address
* Phone Number
FAX Number
1b - Billing Address
* Company
* Address
* City, State, Zip Code
1c - Shipping Address (if different from billing address)
Company
Address
City, State, Zip Code
1d - Carrier Information
* Carrier Name
* Type of Service
Use our Carrier Account	No  Yes	Account Nbr

2a - Product #1 (please enter only one model number in this section)
* Product Type	Select from this Dropdown List Portable Indicator Bench-top Indicator HumidityTransmitter Humidity Temperature Transmitter Data Logger Humidity-Temperature Probe Probe Simulator Water Activity Probe Meteorological Probe Digital Interface HygroStat Alarm Card Other (not in the list)
Model Number		* Quantity
Serial Numbers

* Reason for return	Calibration Only	Repair	Warranty Repair
Problem description (use only for repairs)

2b - Product #2 (please enter only one model number in this section)
Product Type	Select from this Dropdown List No further product Portable Indicator Bench-top Indicator HumidityTransmitter Humidity Temperature Transmitter Data Logger Humidity-Temperature Probe Probe Simulator Water Activity Probe Meteorological Probe Digital Interface HygroStat Alarm Card Other (not in the list)
Model Number		Quantity
Serial Numbers

Reason for return	Calibration Only	Repair	Warranty Repair
Problem description (use only for repairs)

2c - Product #3 (please enter only one model number in this section)
Product Type	Select from this Dropdown List No further product Portable Indicator Bench-top Indicator HumidityTransmitter Humidity Temperature Transmitter Data Logger Humidity-Temperature Probe Probe Simulator Water Activity Probe Meteorological Probe Digital Interface HygroStat Alarm Card Other (not in the list)
Model Number		Quantity
Serial Numbers

Reason for return	Calibration Only	Repair	Warranty Repair
Problem description (use only for repairs)

2d - Product #4 (please enter only one model number in this section)
Product Type	Select from this Dropdown List No further product Portable Indicator Bench-top Indicator HumidityTransmitter Humidity Temperature Transmitter Data Logger Humidity-Temperature Probe Probe Simulator Water Activity Probe Meteorological Probe Digital Interface HygroStat Alarm Card Other (not in the list)
Model Number		Quantity
Serial Numbers

Reason for return	Calibration Only	Repair	Warranty Repair
Problem description (use only for repairs)

3 - General Requirements

Expedite / Rush	No	Yes ($50 charge)
Provide As-found Data	No	Yes (additional charge)
If product can't be repaired	Dispose	Return