1/26/2012

5900 Centerville Rd. REPAIR REQUEST

White Bear Lake, MN 55127
PHONE (651) 429-0999 FAX: (651) 379-3860 R-
TODAY'S DATE: ______________________________

Dealer Name: PUMP SERIAL No.:

Company Name: Transmitter SN:

Contact Person: Receiver SN:

Contact Phone: Other Unit SN:

Ship To:

PARTS SEND: TX RX BATTERY OTHER

Customer P.O. No: _______________________

Return Shipping Instruction: Next Day Two Days Ground Other

►PLEASE REMOVE ANY SHOULDER STRAPS AND BATTERIES BEFORE SHIPPING◄

FAILURE DESCRIPTIONs:

For SAI Use Only

TX RX BATTERY OTHER

PARTS Received:
Notification (IW52) # 3000
Repair Request (VA02)#
Repair Order (IW32)# 600
Delivery #

SAISVC011 REV 110120