Please enable JavaScript in your browser to complete this form. - Step 1 of 2EIT 2.0 LLC Instrument Markets (EIT 2.0 UV Instrument Calibration and Non-Warranty Repair) It is our goal to provide excellent customer service for your unit repair/calibration. To avoid delays in service response time, this form must be filled out in its entirety of highlighted sections and returned with the unit. Company Information & Billing AddressCompany Name *Company Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code-- Select Country --AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta and MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo (DRC)Congo (Republic)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d’IvoireDenmark (Danmark)Diego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedonia (FYROM)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. Vincent & GrenadinesSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaSão Tomé and PríncipeTaiwan, Province of ChinaTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweReturn Shipping Information (Only If Different Than Above)Different Return Address?Different Return Address?Company Name (for return shipping)AttentionCompany Address (for return shipping) *Address Line 1Address Line 2CityState / Province / RegionPostal Code-- Select Country --AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta and MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo (DRC)Congo (Republic)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d’IvoireDenmark (Danmark)Diego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedonia (FYROM)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. Vincent & GrenadinesSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaSão Tomé and PríncipeTaiwan, Province of ChinaTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweReturn Shipping MethodEIT2.0 or Customer Account? *EIT2.0 AccountCustomer AccountEIT2.0 Account *UPSFedEx(EIT 2.0 will contact UPS/FedEx to arrange shipping. Shipping charges will be added to your Invoice) Customer Account *UPSFedExOtherOther Carrier To Be Used *Level of service (UPS)Ground (US)2nd Day Air (US)3 Day Select (US)Next Day Air® (US)1-3 Business Days (International)2-5 Business Days (International)Level of service (FedEx)Overnight (US)2 Day (US)Commercial Ground, 1-5 business days (US)FedEx International Priority® ExpressFedEx International Priority®THE CUSTOMER MUST CONTACT OTHER CARRIERS TO ARRANGE PICKUP. IF USING DHL/OTHER COURIER SERVICE, SHIPPING LABELS MUST BE SENT TO calibration@eit20.com IN A TIMELY MANNER. Your Account # *Do you want your shipment insured, if so for how much?Contact InformationLayoutAccounts Payable (AP) Contact Information AP Contact *AP Email *AP PhoneTechnical Contact information Technical ContactTechnical EmailTechnical PhoneMethod of PaymentInternational and Credit Hold customers are required to make payment transactions prior to services being performed. All customers must provide an e-mail address for billing purposes.Method of Payment *Credit CardWire TransferPurchase OrderDO NOT EMAIL OR INCLUDE YOUR CREDIT CARD INFORMATION ON THIS FORM. YOU WILL RECEIVE INFORMATION FOR PAYMENT VIA EMAIL. YOU WILL RECEIVE INFORMATION VIA EMAIL FOR PAYMENT TO BE MADE ON THE WEBSITE PORTAL. A Bank Fee of $25 will be charged for Wire Transfer PO Only Available to Customers with Established Terms Credit Card Payment Contact Email *Purchase Order # *After submitting this form send your unit(s) to:LayoutEIT 2.0 LLC 900 Sycolin Road, Suite 130 Leesburg, VA 20175 Calibration/Repair Service Contacts E-mail: calibration@eit20.com Voice: 571-578-3075 NOTE: International Customers - Please make sure you label your package in this manner: "TEMPORARY RETURN OF GOODS COMING FOR REPAIR AND SERVICE – AND RE-EXPORT BACK TO THE SENDER". Service Temporary Import Form Important Notice: You the requestor will be financially responsible for any customary fees, for the repair of the equipment, not limited to evaluation fees. Calibration/ServiceModel/Type of Instrument(s), Lamp System(s), and Bulb Type(s)Add each instrument individually. Just click "Add" to add one, or "Remove" if you need to remove one.____________________Model / Type of Instrument *Select model / type of instrument10W MicroCure (UVA)200mW MicroCure (UVA)200W SpotCure (UVA, UVV)20W SpotCure (UVA, UVV)2W MicroCure (UVA)40W LEDCURE - 4CH Profiler40W LEDCURE - L36540W LEDCURE - L365 Profiler40W LEDCURE - L38540W LEDCURE - L385 Profiler40W LEDCURE - L39540W LEDCURE - L395 Profiler40W LEDCURE - L40540W LEDCURE - L405 Profiler40W LEDMAP - 4CH40W LEDMAP - L39540W LEDMAP - L405Hi Power Power Puck IIHi Power Power Puck II ProfilerHi power PowerMAP IIHi Power UVCURE Plus IIHi Power UVCURE Plus II ProfilerLo power PowerMAP IILow Power Power Puck IILow Power Power Puck II ProfilerLow Power UVCURE Plus IILow Power UVCURE Plus II ProfilerMid Power Power Puck IIMid Power Power Puck II ProfilerMid Power UVCURE Plus IIMid Power UVCURE Plus II ProfilerLamp SystemBlue Wave 200 (default)F300LEDLH6Medium Pressure Mercury Arc (default)SuperSpot MK III (default)Bulb Type-DH (Default)H+VSerial Number *Calibration Service Part NumberUnit Type *StandardDemoAdditional RequestsNoneExpedited Calibration Services (additional charges may apply) + Add - RemoveSpecial Instructions/Request: Note: Additional Charges May ApplyI Authorize EIT 2.0 to Perform the Above Listed Services *I Authorize EIT 2.0 to Perform the Above Listed ServicesNextUpdating preview…This is a preview of your submission. 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