Tube Service Report

Please Read Instructions
1. An RA number is required for Warranty Returns.
2. Please use this form for WARRANTY RETURNS ONLY.
3. Complete and e-mail this form by clicking Submit or Print and Fax to 843 760 0079. We will contact you with an       RA number, and shipping instructions.
4. Mark the shipping container and accompanying document with the RA number.
5. Ship the Warranty Return to the address indicated on this form.
6. Customer assumes responsibility for Freight charges and any damage that may occur during shipping.

Dealer Information
	* Required fields
* Name
Address
Fax
OR
* E-Mail
Return Tube Information
*Insert Model
*Serial Number	(e.g. 12345-1A)
Heat Exchanger Model
Serial Number	(e.g. 12345-1A)
Generator Model
Type of Circuit	Single Phase
	Three Phase
	Single Phase Cap Smooth
	High Frequency
Institution (Where was the tube installed)
Name
Address
X-Ray Tube or Heat Exchanger Operation
*Date Removed
Scan Count (CT Only)
*Date Installed
Scan Count (CT Only)
Total Scan Count (CT Only)
Estimated Exposure @ 60 Hz
Estimated Exposure @ 180 Hz
Techniques at Time of Difficulty	kV : mA : Time :
Techniques Most Frequently Used
* Reason for Return
Air in Housing Arcing/Instability Bearing/Noise Calibration Filaments Focal Alignment Grid Heat Exchanger Image Oil Leak* Output Dead On Arrival* Restock - never used Shipping Damage Stator Other*
*Circumstances of Failure / Additional Comments
*Replacement Tube
* Insert Model
* Serial Number	(e.g. 12345-1A)
Person Filing Report
* Full Name
* Telephone
* Date
Fax
OR
* E-Mail