Deublin Company - Privacy Policy - Return/Repair Request Form

Repair Request Form

The field descriptions in RED text are required.
CONTACT INFORMATION

Company Name:
Address1:
Address2:
City:
State: (if applicable)
Zip:
Country:
Contact First Name:
Contact Last Name:
Phone:
Fax:
Email:
Distributor:
Distributor Phone:

OPERATING DATA

Model Number:
RPM:
PSI:
Media:
Temperature:
Is Filtered?	Yes No
Filter Micron/Mesh Size:
How long has the union been running?	days months years
Reason for Return:
Describe Application: (machine type, type of mounting: vertical or horizontal?)

OTHER INFORMATION

INSTALLATION
Piped Solid?	Yes No
Mishandled?	Yes No
Hoses Taut?	Yes No
Run Dry?	Yes No
Installation Other:

Total Unions in this facility?
Number of Unions with this problem?

DUOFLOW ASSEMBLY
Siphon contacting rotor/journal?
Approximate diameter & length:

UNION PROBLEM
Universal throughout plant?	Yes No
Localized to one machine?	Yes No
Localized to one side of the machine?
Is the Union leaking?	Yes No
How fast is the Union leaking?
Where on the Union is it leaking?
When in the cycle is it leaking?

Do you want this Union repaired if possible?	Yes No