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. A simple decision rule is used, where the 'in-tolerance/out-of-tolerance' results are based solely on the measured readings being within the established tolerance. All fields with “*” must be completed before submitting the form. Company Information & Billing AddressCompany Name *Company Address *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ----- 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 ----- 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) - default2nd 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) - defaultFedEx 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 InformationLayoutContact information Contact Name *Email *PhoneAccounts Payable (AP) Contact Information AP Contact Name *AP Email *AP 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 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 # *PO Click or drag a file to this area to upload. 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.____________________Family *Select familyLEDMAP™ - LED Four BandLEDMAP™ - LED Single BandLEDCure® Profiler Four BandLEDCure® Profiler Single BandLEDCure®UV PowerMAP® IIPower Puck® II ProfilerUviCure Plus® II ProfilerPower Puck® IIUviCure Plus® IISpotCure®Model / Type of LEDMAP™ - LED Four Band InstrumentSelect Model/TypeLMAP-4CModel / Type of LEDMAP™ - LED Single Band InstrumentSelect Model/TypeLMAP-L365LMAP-L385LMAP-L395LMAP-L405Model / Type of LEDCure® Profiler Four Band InstrumentSelect Model/TypePL-4C-P40-4CModel / Type of LEDCure® Profiler Single Band InstrumentSelect Model/TypePL-365-P40-4CPL-385-P40-4CPL-395-P40PL-405-P40-4CModel / Type of LEDCure® InstrumentSelect Model/TypePL-365-40-4CPL-385-40-4CPL-395-40PL-405-40-4CModel / Type of UV PowerMAP® II InstrumentSelect Model/TypePM2-HPM2-LModel / Type of Power Puck® II Profiler InstrumentSelect Model/TypePP2P-HPP2P-MPP2P-LModel / Type of UviCure Plus® II Profiler InstrumentSelect Model/TypePLUS2P-A-HPLUS2P-A-MPLUS2P-A-LPLUS2P-B-HPLUS2P-B-MPLUS2P-B-LPLUS2P-C-HPLUS2P-C-MPLUS2P-C-LPLUS2P-V-HPLUS2P-V-MPLUS2P-V-LModel / Type of Power Puck® II InstrumentSelect Model/TypePP2-H-UPP2-M-UPP2-L-UModel / Type of UviCure Plus® II InstrumentSelect Model/TypePLUS2-A-H-UPLUS2-A-M-UPLUS2-A-L-UPLUS2-B-H-UPLUS2-B-M-UPLUS2-B-L-UPLUS2-C-H-UPLUS2-C-M-UPLUS2-C-L-UPLUS2-V-H-UPLUS2-V-M-UPLUS2-V-L-UModel / Type of SpotCure® InstrumentSelect Model/TypeSP1-365-EITSP1-365-ERLamp System (LED)LEDUV PowerMAP® II Lamp SystemMedium Pressure Mercury Arc (default)F300LH6UV PowerMAP® II Lamp SystemMedium Pressure Mercury Arc (default)Power Puck® II Profiler Lamp SystemMedium Pressure Mercury Arc (default)F300LH6Power Puck® II Profiler Lamp SystemMedium Pressure Mercury Arc (default)UviCure Plus® II Profiler Lamp SystemMedium Pressure Mercury Arc (default)F300LH6UviCure Plus® II Profiler Lamp SystemMedium Pressure Mercury Arc (default)SpotCure® Lamp SystemBlue Wave 200 (default)Power Puck® II Lamp SystemMedium Pressure Mercury Arc (default)F300LH6Power Puck® II Lamp SystemMedium Pressure Mercury Arc (default)UviCure Plus® II Lamp SystemMedium Pressure Mercury Arc (default)F300LH6UviCure Plus® II Lamp System Medium Pressure Mercury Arc (default)BulbH (Default)DVH+Serial Number *Calibration Service Part NumberUnit Type *StandardDemoAdditional RequestsNoneExpedited Calibration Services (additional charges will apply)Special Instructions/Request: Note: Additional Charges May Apply + Add - RemoveSpecial Instructions/Request: Note: Additional Charges May ApplyAfter submitting this form send your unit(s) to:LayoutEIT 2.0 LLC 14001 Innovation Park Lane, Leesburg, VA 20176 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. I authorize EIT 2.0 to perform the above listed services and give consent to receive electronic communication from EIT 2.0 *I authorize EIT 2.0 to perform the above listed services and give consent to receive electronic communication from EIT 2.0NextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit