Mammography Tubes Warranty

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
* X-ray Tube Type:		* Serial Number:

Dates
*Tube Received	Ex. MM/DD/YYYY	*Tube Installed	Ex. MM/DD/YYYY
*Tube Removed	Ex. MM/DD/YYYY

*Reason for removal of service:

Manufacturer of Generator:

Manufacturer Type:

*Type of Circuit
Single Phase:		Three Phase:
Single Phase Cap Smooth:		High Frequency:

*Number of Exposures:
Techniques at Time of Difficulty
* kV	* mA		* Time
Techniques Most Frequently Used
* kV	* mA		* Time
Maximum Exposure Techniques Used
* Max kV used:		* Max mA used:

High voltage cables/components replaced monthly? Yes No

Have there been previous tube failures? Yes No

If so, when and for what reason?

Replacement Tube Type
* Insert Model:		* Serial Number:

Additional Comments:

Email by clicking Submit or Print and Fax to 801.973.5050

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Production of any of the material contained herein in any format or media without the express written permission of Varian Medical Systems is prohibited.