Setra Systems Calibration & Service Form

Declaration of Contamination (Note: Setra cannot accept parts that have any type of contaminants inside the pressure port unless purged & cleaned with proof of decontamination process.) *

Unit(s) has only come in contact with either Air, Nitrogen, Helium, or water Unit(s) has been installed and has come in contact with ANYTHING other than the 4 substances listed above including but not limited to any hazardous media listed in 40 CFR 372.45.40 or CFR 355 Appendix A and B
List all materials the unit(s) were exposed to: *
Optional Additional Notes
PLEASE ATTACH a copy of the documentation of the decontamination process. This must be submitted to Setra for review and approval by Setra prior to returning product to Setra (Please note: Approval to return to Setra is required and delays may occur.) *

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Please read and accept *

I certify that the information contained in this declaration is true and complete. I am aware that Setra is relying on accuracy of the statements contained in this declaration. The below named company understands and agrees that it shall be responsible for any claims based on any false or incorrect statements contained in this declaration. I accept that if a unit is found to be contaminated with hazardous material and it subsequently causes harm to any Setra associate, the customer shall be liable for this harm or injury.
Your Name *

First Name Last Name
Company *
Signature *

Clear
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Please Note: A separate form fill will be needed if you plan on servicing/returning multiple models.
Model / Part Number *
Quantity *
BEFORE PROCEEDING!

→ Click here ← to check if your unit(s) is under warranty.

Incorrect information may lead to delays.

If product is in warranty but is not found to be defective the evaluation fee will apply.
Is the unit under warranty? *

Yes No Serial number is illegible (Illegible serial number voids warranty)
Are the units under warranty? *

Yes, all the units are under warranty No, all the units are out of warranty Some of the units are under warranty, some are out of warranty Serial numbers are illegible (Illegible serial number voids warranty)
Enter Each Serial Number (Click the plus button to add more) *
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Billing Address (You will not be billed if unit is in warranty and confirmed defective) *

Please select a payment method below: *

Purchase Order Credit Card The unit(s) is under warranty, no payment is required (incorrectly selecting this option will cause delays)
Purchase Order Number (if calibration or non-warranty) *
A valid PO # must be entered. Entries that include NA, TBD, Quote, etc. will be delayed. If in warranty and failure is determined to be an application or customer issue, evaluation fees would apply.
Not to exceed amount *
Please continue with the form. A customer service rep will reach out after submission to get your credit card details.
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Shipping Info

Please fill in the information below so we can ship the product back to the correct person.
Shipping information is the same as the billing information.
Ship to Attention *

First Name Last Name
Ship to Company *

Shipping Address *

Shipping Info