X-Ray Tubes Housing

Tubes must be prepaid with a completed Tube Service Report describing the reason for return, operating conditions, Installed and removal dates in order to recieve Warranty consideration.

* Required Fields
Salutation
* First Name
* Last Name
* Phone:
* Email:
* Date:	Ex. MM/DD/YYYY

	* Dealer * OEM
* Dealer/OEM:
Address:
* City:
* State/Province:
Postal Code:
* Country:

* Institution: (Where Tube Installed)
Address:
* City:
* State:
Postal Code:
* Country:
Fax:

Return Tube Information
* Insert Model:		* Serial Number:
Heat Exchanger Model:		Serial Number:
Generator Model:		Serial Number:

* Principal Usage
	Cine	Fluoro-Spot Film	Special Procedure
	Remote Table	General Radiography	Tomographic
	Pulsed Fluoro

X-ray Tube Operation or Heat Exchanger (if returned separately): Anode Rotation Speed
* Date Removed:	Ex. MM/DD/YYYY	Exposure Count:
* Date Installed:	Ex. MM/DD/YYYY	Exposure Count:
		Total Exposures:
Estimated Exposures @ 60Hz
Estimated Exposures @ 180Hz

Techniques at Time of Difficulty
* kV	* mA		* Time
Techniques Most Frequently Used
* kV	* mA		* Time
Radiographic Technique
Max kV used:		Max mA used:

* Describe in detail the circumstances and reasons for the removal and return:

Replacement Tube
* Insert Model:		* Serial Number:

Additional Comments:

Email by clicking Submit or Print and Fax to 801.973.5050