TM Electronics Service, Calibration or Return Material Authorization (RMA) Request Form

Name: TM Electronics, Inc
Address: 68 Barnum Road, Devens, MA, 01434
Telephone: +1 (978) 772-0980
Price range: $

Use this form for Service, Calibration, RMA or Expedited Calibration

PLEASE NOTE NEW SHIP TO LOCATION
New Manufacturing, Service and Distribution Address effective 5/1/19
TM Electronics Inc.
68 Barnum Road
Devens Massachusetts
01434-3508

Your Billing Information

Firstname*:
Lastname*:
Title:
Company*:
Address*:
Address 2:
City*:
State:
Zip*:
Country*:
Email*:
Phone*:	Ext.
Fax:

Instrument / Equipment Information

Type of Instrument/Tester: Solution Worker WORKER Integra BT-1000 BT Integra Ion Leak Tester LA-01 (Digital Flow Valve) LA-04 (Flow Standard) MDT Series ES-1000 ET-100 Other

Serial Number:
Model:

Reason for Return: Calibration of Instrument (Burst/Package or Leak/Flow Tester) Expedited Calibration Flow Verification (LA-01 or LA-04) Repair Only Repair and Calibration Instrument Evaluation Other

Return Shipment Info

Ship Via:
Shipping Account Number:

Note: If you do not have a preference on shipping account number, we will add the shipping costs to the cost of the repair and/or calibration.

Shipping address:

Use billing Yes No

Firstname*:
Lastname*:
Title:
Company*:
Address*:
Address 2:
City*:
State:
Zip*:
Country*:
Email:
Phone:	Ext.
Fax:

Special Shipping Instructions:

Instrument Use Information:
Please select the appropriate "Use(s)" from the following: Instrument has not been used Instrument has only been used with clean, dry, inert gas (Air, Nitrogen, Argon, Helium) Instrument has been exposed to non-inert gases, oil, liquids, powders, biological, or radioactive agents

Please list all materials that the instrument has been exposed to:
Has the instrument been properly cleaned so that it is safe for human handling? Yes - N/A (information not available) No

Purchase Order:
Attach File:


	REMINDER-NEW ADDRESS TM Electronics Inc. 68 Barnum Road Devens Massachusetts 01434-3508

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