Return Authorization Form
Company Information
Report Date:*
Customer Name:*
Company Name:*
Telephone Number*
Fax Number
Email Address:*
Confirm Email Address:*
Tool Information
Equipment ID*
Serial#
Problem Identification
Symptoms*

Please provide as detailed description of the symptoms as possible. 
Example logs and copies are extremely helpful. 
Be sure to include a copy of the calibration block with all printed logs. 
These items may be shipped with the tool or attached to this form.

Error Messages
Attach Zipped Log Files:
Warranty Information

This document is our authorization to repair your equipment.

  • Warranty Repairs(generally one year after invoice date for NEW tools )
    should be specified below, with the invoice number and date. 
  • Items not covered under warranty, such a PM Tubes, Gamma Crystals, and
    Mechanical Damage will be invoiced prior to shipment and paid via Credit Card. 
  • All repairs on existing tools have a 60-day warranty. 
    Century will not cover warranty if damage occurs during shipment.
  • For International Customers, all returned items for repair should be marked
    with the Tariff Number 9801.00.1012.
  • All Repairs must have customer credit card number on file, prior
    to returning to Century Geophysical Corp,
  • Invoice must be paid prior to shipment
    of the repaired part back to the customer.
I Understand the Above Terms*
Is this a Warranty Repair?*
Invoice Number
Invoice Date
Billing Information

Rates and Charges

Always Diagnostic Charge (to Check and verify Problems-always required) $200.00 US
  Labor Rate for NonWarranty Repairs $85.00 US per hour plus parts.

(foreign shipments only) As Required


You may enter your Credit Card Information Here or
Contact our Sales Department at 918.838.9811 extension 125 to verbally give this information.
Credit Card Type:
CreditCardNumber
Name On Card
ExpirationDate
Bill To Address
Addr1:*
Addr2:
City:*
State or Province:*
Zipcode:*
Country:*
Shipping Information
Foreign Shipments
Is this a shipment originating from outside the United States?*
If Shipment is from Outside the US, What is the Declared Value (in US Dollars?):

ATTENTION INTERNATIONAL CUSTOMERS:

All requests for a Return Authorization form originating from outside of the United States require the customer to supply a stated value of the equipment for customs purposes.  If customer does not provide a declared value of the equipment, Century will not issue a repair authorization.

PLEASE NOTE- Customer is responsible for accurate representation of the value of the item shipped to Century; Century will rely upon the value stated by customer for all customs paperwork.  Failure to state accurate values can lead to customs delays in customer’s country of origin in addition to fines by customs authorities.
All shipments are returned to the customer COD (COD not available for FEDEX),
Freight Collect or on customer account number.
Ship to Address
Address1*
Address 2
City:*
State or Province*
ZipCode*
Country*
Insure Returned Equipment?*
Insurance Value
Ship Via
Customer Acct No

PLEASE BE ADVISED

  1. Third party billing not available for UPS Ground
  2. COD shipments to Century are not permitted and will delay repair of equipment.
  3. Century will make all efforts during return shipments to ship and insure items as specified.
    However in no case will Century be liable for any errors or omissions in shipments
    or requested insurance coverage of equipment.
  4. Software on computer systems may be upgraded or replaced during repair and testing.
    Be sure to back-up all logs, special applications, etc. prior to returning equipment
  5. All shipments must be made "Door to Door"and "Free Domicile" including duties and taxes.
  6. Waybill must be marked "Free Domicile"including duties and taxes and Door to Door.

Fax a copy of the waybill to Century immediately after shipment (918) 838-1532.
Failure to follow these procedures will result in a delay in the repair and return of your equipment.

Confirmation
I Understand the Rates and Terms*
Check the above if you understand and agree to the terms and rates as described on this
form and authorize such repairs to be made to the specified equipment. 

Be sure to fill in all REQUIRED (*) fields.
 If you receive an error message after pressing the "Submit" button
Correct the form in the required areas, then press "Submit" Again

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Created by Century Geophysical Corp.