Questions marked with a * are required
Dear Valued Customer,
 
Thank you for contacting us.  Please complete all sections of the form and submit. Once reviewed, AMETEK Land will send you authorization, instructions and conditions for return.  Please complete one form for each uniquely serial numbered instrument you wish to return.
Owners declaration of Health & Safety
By providing a contact name & e-mail address the owner is declaring that the equipment being returned is free from any form of contamination or hazard harmful to human health.
Name of person making declaration
I declare that the equipment being returned is free from any form of contamination or hazard harmful to human health
Customer Information (Mandatory)
Company Name
Billing Address
Shipping Address
(If different from billing)
Country
Contact Name
Contact Phone Number
Contact Email Address
Quality Manager Name
Quality Manager Email Address
Please indicate your industry type
Equipment details (Mandatory)
Model
Serial Number
Reason for return including any symptoms of fault or further information.
Services Required
Yes
No
Overhaul & calibration adjustment to manufacturer’s specification
  • Required: Complete Unit Diagnostics & Section A or B on Certification Worksheet
ISO 17025 certification (Infrared thermometry only)
  • Required: Complete Section C on Certification Worksheet
Repair
Parts Exchange (Discount program for New Unit Replacement)
Warranty Evaluation
  • (failure within our general terms – please see user guide for details)
Other reason (as specified above)
Unit Diagnostics Worksheet (Mandatory)
Yes
No
Is the instrument within its initial warranty period?
Good
Average
Poor
How would you describe the equipment’s condition?
Fully Operative    
Partially Operative
Non-Operative 
Does the equipment appear to be operative?
Yes
No
Is the output fixed or displaying excessive instability?
Could the equipment have been incorrectly wired, received an electrical surge or exposed to strong electromagnetic field?
Has the equipment been damaged?
If Yes:

Yes
No
Does the equipment switches on/off, and power up normally?
Does the equipment have switch, terminal, connector or connection faults?
Is the display or output responsive to the process being measured or an electrical input (if applicable)?
Do you suspect the instrument is operating outside specification or giving inaccurate measurement?
Is the software/firmware functioning correctly?
Is the instrument communicating with external devices (if applicable)?
Are the optics clean when viewed through the lens and externally?
Does the equipment have damaged optical, alignment or focusing components
Is the equipment displaying an error message?
Certification Worksheet
Select only ONE option – Please complete the Certification Section A OR B for Calibration & Overhaul services OR Section C for 17025 certification.
Section A
Re-calibrate
For Recalibration Only – Customers may select “Same as Previous” option
  • The cost will be based on the previous service selected and will follow guidelines below
Same as Previous (Land Certs only) 
Land Cert #
Section B
Overhaul
Overhaul - includes ISO Accredited Range Calibration Certificate
  • Customer specifies temperature range for certification – If no range is specified, the instrument operating range will be used
  • This includes 4 hours of labor to clean, repair and calibrate the unit. Any parts and/or additional labor will be charged at the standard rate
°C  (Celsius)
°F  (Fahrenheit) 
Temperature Preference:
Low Temperature Point:
(Required)
High Temperature Point:
(Required)
Section C
17025 Cert
Calibration Certificate IAW ISO 17025 (Minimum 3)
  • Customers must specify temperature points - at least 3 points are required. Additional fees will be charged for additional points.
  • Customer will specify As Found Data, As Left Data or As Found/As Left, as defined below
  • Measurement uncertainties are reported for each test point – this applies only to instruments specified on our ISO 17025 Scope of Accreditation
  • Customer may specify calibration interval – due date will be blank if none are given
°C  (Celsius)
°F  (Fahrenheit) 
Temperature Preference:
Please specify Temperature Points:
1:
2:
3:
4:
5:
6:
7:
8:
9:
10:
As Found Only
As Left Only
As Found / As Left
Please Choose Only One
  • As Found Only: Upon receipt, the unit will be powered on to verify operation, then certified at the points specified by the customer without any lens cleaning, adjustment, repair or calibration.  Please note – This option is NOT available if the unit needs repaired. 
  • As Found/As Left:  The As Found data will be collected as above, analyzed and reported.  If needed, the instrument will be optimized.  The As Left data will be collected and reported as well.  Customers will be charged for each temperature point reported on the certificate.  Should no adjustment be needed, the charge will be for the As Found data only.  Please note – should the unit need to be repaired, the As Found data cannot be collected, or reported.
  • As Left Only:  Upon receipt, the unit will be evaluated, repaired, and calibrated if necessary, as authorized by the customer.  Next, the unit will be cleaned and certified at the points specified by the customer.
Calibration interval:  
Months / Year(s)
.
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