Recalibration Form
1391 E. Boone Industrial Blvd., Columbia, MO 65202
(312) 260-6055 | info@fieldsenseusa.com
1. Please include a check for the total amount due above, or
2. Please provide your Credit Card Payment Information (Visa, Mastercard, Amex)
Payment
SIGNATURE: _____________________________________________________________________________________________________
1. Place the completed recalibration form inside the shipping box. (Keep a copy for your records.)
2. Ship your recalibration request to:
FIELDSENSE RECALIBRATION
1391 E. BOONE INDUSTRIAL BLVD.
COLUMBIA, MO 65202
NAME ON CARD: ______________________________________ BILLING ZIP CODE: ____________________________________
CARD TYPE: __________________________________________ CARD NUMBER: ______________________________________
EXPIRATION DATE: ____________________________________ SECURITY CODE: _____________________________________
NUMBER OF UNITS: ___________________________________ X $150.00 = SUB TOTAL: _______________________________
FREIGHT $15 ($25 FOR ALASKA, HAWAII OR INTERNATIONAL) OR CHARGE TO UPS ACCOUNT NUMBER: ________________
LIST SERIAL NUMBERS OF UNITS RETURNING: _____________________________________________________________________
Recalibration is $150.00 per unit. Please specify the number of units you are including in this shipment for recalibration:
TOTAL: _______________________________________________
Customer Information
EMAIL: __________________________________________________________________________________________________________
SPECIAL INSTRUCTIONS: _________________________________________________________________________________________
ADDRESS: _______________________________________________________________________________________________________
CONTACT NAME: ______________________________________ PHONE NUMBER: _____________________________________
CITY: ___________________________________________________________ STATE: ___________ ZIP CODE: ____________
DATE: ________________________________________________ CUSTOMER PO#: _____________________________________
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