Optical Head Serial Number: (* for LRS-455, LRS-462, PR-1980A And PR-1980B)

(Please fill in requirements - * for special calibration or documentation)

I pre-approve expedited repairs and calibrations for the above instrument not to exceed $

I certify that I am authorized to make this pre-approval and will make sure all charges up to the not-to-exceed amount will be paid.

If Resale/Tax Exempt please fill out the PDF Resale form available here and send it to: Fax: (818) 725-9770 -OR- Email: productservice@jadaktech.com

User Information
Buyer Information
Billing Address
Shipping Address
I have read all the information and terms contained in this document
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Enter the characters shown in the image.