Date: Item(s) returned for: Calibraon Repair Other
Company
Name:
Contact Person:
E-Mail:
Phone: (
Bill to Address: Ship to Address:
Ship Via: UPS FedEx Other:
/
)
E-mail:
(End-User)
Form 3 4 ver: 2021 Feb
Instrument/Probe Model
Number
Serial Number
Instrument/Probe Model
Number
Serial Number
MAILING ADDRESS TEL US / CAN PHONE FAX WEBSITE
Expiration:
Phone: (
Pay Online: https://ludlums.com/pay
Email Estimate
Purchase Order #
Credit Card #
-
- -
Contact Person:
(Purchasing)
Fax: ( )
Malfunconing Symptoms, Special Instrucons, e tc:
LUDLUM MEASUREMENTS, INC.
ATTN: SERVICE DEPT.
501 OAK ST. SWEETWATER, TX 79556 • 1.800.622.0828 • 325.235.5494 • 325.235.4672 • www.ludlums.com
Ludlum Measurements, Inc. is legally obligated to manage information obtained or created during the performance of calibration activities. No information will be made public without the consent of the customer. All information is
considered proprietary and will be regarded as confidential. If Ludlum Measurements is required by law to release confidential customer information, the customer WILL BE notified unless customer notification will impede the investigation.
This confidentiality clause applies to ANY person that acts on the company’s behalf or has access to the calibration laboratory (e.g. contractors, external bodies, committee members).
NOTE: We no longer call for credit card
information. You may enter your credit
card information on this form, or pay
online using the link above.
