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Service Request Form
Required information is in red.
If you would like technical assistance or want to arrange field service, please provide the information requested in the form below. You may also call us directly at (800) 822-1297. In order to provide telephone technical support, ECI must have a signed release form on file for your company. Please download our Release Form and proceed according to its instructions. Please have the following information available to facilitate our assisting you.
Equipment Information
Equipment Manufacturer: Equipment Model #:
Equipment Serial #: Year of Manufacture:
Output Power: Output Frequency:
Input Voltage: Input Frequency:
Power Control Type: Oscillator Tube Type:

List any accessories such as RF Output Transformer, RF Transfer Switch,
Flexible Leads, Co-Axial Leads (rigid or flexible), etc.

Briefly describe the process this unit is used for
Describe the problem in detail providing panel meter readings

Customer Information — Equipment Location

Contact Person
(Name First):
Contact Person
(Name Last):
Title: Company:
Address: City:   
State:     Postal Code:     Country:  
Telephone:    - 
Fax:   - 
Email:
Priority Level:    ASAP   1 Week    2 Weeks   Future
Best Airport to Use:     
How would you like us to contact you?       Call    Fax    Email

Customer Information — Billing Information
(Please supply any information which differs from the above)

      
  We Accept Credit Card Orders by Phone at (800) 822-1297.

Payment Type:       C.O.D.      On Account      Credit Card*

*Credit card orders must be authorized by telephone unless current information is on file with ECI.

Contact Person
(Name First):
Contact Person
(Name Last):
Title: Company:
Address: City:   
State:     Postal Code:     Country:  
Telephone:   - 
Fax:   - 
Email:


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East Coast Induction, Inc.
P.O. Box 2039
Brockton, MA 02305-2039
Telephone: (508) 587-2800
Fax: (508) 587-9079
  

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