Calibration Request Form
EXPERIENCED TECHNICAL SUPPORT, SERVICE AND CALIBRATION

All of the information requested below is required so that your order may be processed without delay. Please complete this form fully and print a copy to enclose with your unit. If you are not a current Gould-Bass customer, we can ship C.O.D. in order to eliminate delays. If you prefer, however, you may enclose appropriate credit reference information so that we may submit your account for credit approval.

Your Name:
 Phone Number:
 e-mail address:
Company Name:
 Fax Number:
Purchase Order Number:

Date:
Shipping Address:

 Billing Address:

Model Number:

Other Models Not Listed Above:

Serial Number(s):

This unit is functioning correctly.

 

Payment Method :

This unit is not functioning correctly. .Explain:

Shipping Method:

Account Number if required:

Please print this form and enclose a copy with
your shipment to:
Attention: Calibration Department
GOULD-BASS COMPANY, INC.
1431 W. Second Street
Pomona, CA 91766
*UPS/Blue Label shipping is provided free within the continental US.
Gould-Bass Company, Inc., - 1431 W. Second Street, Pomona, CA 91766 - (909)623-6793, - FAX (909)629-1467