Under Construction Please visit our main site at www.cirris.com This is a test page, please do not use, go to www.cirris.com Contact Us First Name * Last Name * Company Name * Job Title Email * Phone Number Country * - Please Select -United States of AmericaAfghanistanAlbaniaAlgeriaAndorraAngolaAmerican SamoaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDemocratic People's Republic of KoreaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRepublic of KoreaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaState of PalestineSudanSurinameSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUruguayUzbekistanVanuatuVenezuelaViet NamYemenZambiaZimbabwe State * - Please Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming City and Zip Comment/Question * Captcha Submit If you are human, leave this field blank. This is a test page, please do not use, go to www.cirris.com RMA Request Contact Information First Name * Last Name * Company Name * Email * Shipping Method * - Please Select -UPS Next Day AirUPS 2nd Day AirUPS GroundUPS 3 Day SelectUPS Worldwide ExpeditedUPS Worldwide SaverUPS Worldwide ExpressFedEx 2DayFedEx Priority OvernightFedEx Standard OvernightFedEx GroundFedEx International EconomyFedEx International PriorityDHL Express WorldwideWill Call This shipping method will be used to ship your product back to you after repair as well as if you opted to have a Loaner tester shipped to you. ***DHL is for International Shipping Only!*** Preferred Shipping Payment * - Please Select -Collect on your Account NumberPrepay and Add to Invoice Shipping Account Number * Billing Street Address * Billing City * Billing State/Region * Billing Postal Code * Billing Country * Is the Shipping Address the same as the Billing Address? Yes Shipping Street Address * Shipping City * Shipping State/Region * Shipping Postal Code * Shipping Country * Tester Information What items need servicing? * - Please Select -TesterAdd-OnsTester and AddonsOther Tester Serial Number * Cirris Product * - Please Select -1000HX1000RX1100H+1100R+4200425081008100 Add-OnCH2CH2 ChassisCH2 Scanner ModuleCR Add-OnCR BaseCR BoosterEasy TouchEasy Touch PROPerformance Check KitPin-SightxHV CH2xHV Scanner ModuleOther Other Tester Type * How many scanner modules are in your chassis? * Easy-Wire Version * Cirris Server Being Used for Networked Database? Cirris Server is Being Used for Networked Database Do you have any Expansion Add-Ons that are coming in with your tester? * - Please Select -YesNo How many Add-Ons? * Serial Numbers of Add-Ons * Separate each Serial Number with a comma (,) Please Provide Detailed information for Service * the more detail given the easier it will be working the issue Optional Services Loaner Loaner Loaner testers are chargeable based on tester type, shipping method, and add-ons. The Loaner Fee will be applied to the repair order when we evaluate your tester. (Loaners are for Domestic Customers Only) Loaner Tester Type * - Please Select -1100H+1100R+4200425081008100 Add-OnCH2CR Add-OnCR BaseEasy TouchEasy Touch PROxHV CH2xHV Scanner Module Expedite Expedite If checked, this will add an additional $385.00 to the service charges incurred. Calibration * Yes No Calibration is a chargeable service regardless of warranty status. Fee is based on tester type and if add-ons were included with tester. All testers that go through our service department are tested to our calibration standards, however, only paid calibration services will we provide the calibration certificate. Submit If you are human, leave this field blank. Section Credit Application Company Name * Company Website Corporate Phone * Federal ID * Prior Business Name D&B AP Contact Name AP Contact Phone AP Contact Email Billing Email Billing Preference * - Please Select -EmailPortalOther Portal * Other Billing Preference * Corporate Address Street Address * City * State/Region * Country * Postal Code * Billing Address is the same as Corporate Address Billing Address is the same as Corporate Address Billing Address Billing Street Address Billing City Billing State/Region Billing Country Billing Postal Code I have references to provide I have references to provide Trade Reference Credit checks may take up to 10 business days. If we receive a negative response from your trade reference, or no response at all, you will be placed on 100% advance terms. Reference #1 Name Reference #1 Phone Reference #1 Email Reference #1 Company Reference #1 Address, Country, Postal Code Trade Reference #2 arrowup6 Reference #2 Name Reference #2 Phone Reference #2 Email Reference #2 Company Reference #2 Address, Country, Postal Code Trade Reference #3 arrowup6 Reference #3 Name Reference #3 Phone Reference #3 Email Reference #3 Company Reference #3 Address, Country, Postal Code Information on Principals Name Address Phone Position Name Address Phone Position Name Address Phone Position Signature Disclaimer 1 I/We certify that this information is correct, complete and that we are able to pay within the terms granted. I/We further understand that the Seller will rely on this information for the extension of credit. Disclaimer 2 I/We authorize the Seller from time to time to obtain Business Credit reports on the company listed above. This is not an agreement by the Seller to lend money; it is an agreement by the Customer for the benefit of the Seller if the Seller determines to extend credit. Seller may change credit limits or other credit terms at any time, in its sole discretion. Disclaimer 3 Customer agrees that any amount not paid within terms will be subject to interest at a rate of 1.5% per month, and agrees to ay all costs incurred in collection, including attorney’s fees in the amount of 1/3 of the total balance due if this account is place with an attorney for collection, whether suit is filed or not. This Agreement shall be governed and construed in accordance with the laws of the State of Utah. First Name * Last Name * Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.
