CUSTOMER AUTHORIZATION FORM (RMA# 3283 )

RETURN FAX # (954) 946-9375

Re: Your Purchase Order# PLEASE PROVIDE Date: January 15, 2014

Contact Person: DAVID RENDON

Company & Shipping Address Company & Billing Address

INDERCOLOR SAS SAME
CALLE 19 NO 1B 120 MADRID
BOGOTA, COLOMBIA
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SERVICE INFORMATION
Material Rcvd: DF-6001F S/N : 27880
-The item(s) are not repairable but can be traded in for a new item listed below.

-New Item # DF-656103

-Description F1 STD POSITECTOR 6000 III INT PROBE 0-60 MIL
-Cost $625.00 Less Trade-In 20% = $500.00 plus delivery and tax if applicable.
-Delivery will be determined upon receipt of your authorization to proceed.
-Reason: LE FALTA LA PUNTA PROE DE ZAFIRO LO QUE OCASIONA QUE LAS MEDICIONES
DEL INSTRUMENTO SEAN FUERA DE TOLERANCIA, NO TIENE REPARACION. ESTE ES EL
PRECIO DE UNA UNIDAD NUEVA CON EL 20% DE DESCUENTO POR INTERCAMBIO DE LA
UNIDAD DESCOMPUESTA.
___________________________________________________________________________
RETURN INFORMATION

***PLEASE (CHECK ONE)***: -TRADE -RETURN UNSERVICED -DESTROY

_________________________________________________________________________________
SHIP VIA: (Please note all orders will ship UPS Ground Prepay & Add unless otherwise specified)

-UPS -FedEx -Airborne -DHL -Specify Other ___________________

□ Ground □ Prepay & Add Account # _________________________________________

□ 3rd Day □ Collect (Will ship collect, unable to pre-pay and add these services)
□ 2nd Day □ Consignee
□ Next Day
Signed: __________________________________ Company: _________________________________

Paul N. Gardner Company, Inc. ● 316 NE First Street ● Pompano Beach, Fl 33060
1-800-762-2478 ● (954)946-9454 ● (954)946-9309

To maintain our high level of customer service we ask that you respond to all repair evaluations within 90
days. After 90 days without a response, instruments are subject to return or disposal. If you have
questions or concerns relating to this evaluation please contact us directly and we would be happy to
discuss it with you.