www.suntrac.com  (print this form and return with meter)                                    Date ________________
SUNTRAC SERVICES, INC.
Return Goods Form
(Please fill in the appropriate information for each shipment.)

Instrument(s) returned for:  ___ Calibration     ___ Efficiency       ___ Repair 

Bill to address:
_
Company Name: _________________________

Accounts Payable: _______________________

E-mail: ________________________________

Address 1: ______________________________

Address 2: ______________________________
 
City, State, Zip Code: _____________________
 
 

Check Source Included:  ____ Yes  ____ No
Ship to address: ___ Same as Bill To Address 
_
Company Name: _________________________

Contact/Technical User: ___________________

_
E-mail: _________________________________
_
Address 1: ______________________________
_
Address 2: ______________________________
_
City, State, Zip Code: _____________________
_
Phone Number:  _________________________
_
Fax Number:  ____________________________
Instrument /Probe
Model Number		 _
Serial Number 		 Instrument / Probe
Model Number 
_
Serial Number 
       
       
Malfunction Symptoms, Special Instructions, etc. 

Please check the appropriate billing option:
____ Charge Credit Card (Please circle)     ____ Invoice with Purchase Order   ____ W/O Purchase Order
        Visa/Master Card/American Express                    PO #: _____________________________________
        No.: ______________________________    PO Contact: _____________________________________
        Exp.: _____________                                 Phone/Fax: _____________________________________
        Name: ____________________________            E-Mail: _____________________________________
        Credit Card Verification Code:  _________

SHIPPING INFORMATION:  All packages will be shipped back UPS ground service unless otherwise 
specified.  We cannot ship to Post Office Boxes, street addresses only.  Shipping charges will vary quantity, 
as to item(s), weight, size and destination.

1818 EAST MAIN STREEET                                                                                                                               LEAGUE CITY, TX 77573
(281)338-2133                                                              email : jryan@suntrac.com                                                  FAX:(281)338-2136