| Company Name |
* |
|
| Customer Contact |
* |
|
| Customer Phone Number |
* |
|
| Customer Email Address |
* |
|
| |
|
|
| Ship to: Street Address |
|
|
| Ship to: City/Town or Locality |
|
|
| Ship to: Province or State |
|
|
| Ship to: Postal Code |
|
|
| Ship to: Country |
|
|
| |
|
|
| Item Number 1 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 2 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 3 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 4 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 5 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 6 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 7 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 8 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 9 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 10 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 11 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 12 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 13 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 14 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 15 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 16 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
Select
Electrical
Mechanical
Software
Packaging/labeling
Damage
Other
|
| Detailed Description |
* |
|
| Service Level |
* |
Select
Analysis Only
Analysis and Service
Service Only
Upgrade
Other
|
| |
|
|
| Item Number 17 |
| Customer Part Number |
|
|
| Avanex Part Number |
|
|
| Avanex Serial Number |
* |
|
| Return Category |
* |
|