Calibration & Service Order Return Form

Fill out all lines in all sections A, B, C & D. Orders that arrive without this completed form will be held pending proper paperwork.
Setra requires that you receive an RMA number prior to shipping and that the RMA number is placed on the outside of the shipping box.
Remove all fittings and power cords before returning parts for service. We are not responsible for lost cords or fittings.
Scale returns should be returned to us with the pan and power cord.

A - Declaration of Contamination:

Has the product been used? (Check the appropriate box and provide requested information)

No, Never installed

Yes, installed but not contaminated; has only come in contact with clean, dry, inert gas or non-hazardous liquid (Example: Air, Nitrogen, Helium, water) (Must provide valid media).


List all materials the unit(s) were exposed to:


Yes and contaminated; has been installed and has come in contact with hazardous media listed in 40 CFR 372.45.40 or CFR 355 Appendix A and B, or any other hazardous material or biohazard material. Returned goods must be accompanied by MSDS forms for all materials and must be cleaned and made chemically inert with no trace of chemicals.


List all materials the unit(s) were exposed to:

Describe in detail the decontamination process used:


I certify that the information contained in this declaration is true and complete. I am aware that Setra is relying on accuracy of the statements contained in this declaration. The below named company understands and agrees that it shall be responsible for any claims based on any false or incorrect statements contained in this declaration.

Digital Signature:

On Behalf of (Company Name):

B - Customer Address, Contact & Shipping Information:

Billing Information


Contact Name

Contact Phone

Contact Email

Company Name

Billing Address

Billing City/State/Zip/Country

Purchase Order Number(for this return)

Shipping Information

Shipping Address is same as Billing Address

Ship To Attention

Ship To Phone

Ship To Email

Ship To Company Name

Ship To Address

Ship To City/State/Zip/Country

Original Purchase Order Number(Warranty Credit Only)


Shipping method:
How you would like your return order shipped back to you?

Shipping Carrier

Shipping Method

Shipper Account #

If no account is provided, parts will be returned to you on Setra's preferred carrier and charges will be added to your invoice.

C - Product Information - Reason for return:

Reason for return: Please provide a detailed description of the failure. Provide as much detail as possible to properly evaluate units.

Complete Part Number(s):

Serial Number(s):


Date Code(s):

Calibration Only - Includes As found & As left certs

Standard repair - Written description of findings to be included with every repair order


Written Failure analysis required - Includes long term and destructive testing, as well as a formal written response with a Containment and Corrective Action plan. An additional charge will be applied to all units that are out of warranty requiring Failure Analysis. Failure Analysis testing cannot be expedited and the unit may not be repairable after the analysis is complete. Lead time is extended on all failure analysis returns.

D - Payment Information:




If Yes, Please provide a not to exceed amount for each unit