Equipment ShipmentConfirmation Form

Equipment Shipment

Confirmation Form

Please ship your test kit to:

Specialty Valve & Controls

9115-K Old Statesville Road

Charlotte, NC 28269

**Write the SERIAL NUMBER of your gauge on the OUTSIDE of the box before sending to us.

Please enter your information below so we can match your equipment to your account when we receive it in the mail.

Company Name*

This name will appear on your equipment's certification paperwork.

Contact Name*

Who do we call if repairs are needed?

Contact Phone Number*

What is the number for the contact person?

Shipping Address*

We will return your gauge to this address.

Example: 123 Main Street, City, ST 12345

Billing Address*

Physical billing address

Email Address for Work Notifications*

We will send an email here letting you know the status of your order.

Email Address for Billing*

We will email the invoice here.

Serial Number*

What is the serial number of the gauge you are sending to us?

**Please WRITE THIS NUMBER on the OUTSIDE of the SHIPPING BOX.

Manufacturer

Optional

Select or enter value

Model

Optional

Notes

Comments/known issues?

Purchase Order Number

*Please include this if your company requires a PO for payment. Thank you!

File Upload

Feel free to upload your PO information here. We will attach it to your order when we receive your shipment.

Drag and drop files here or

Send me a copy of my responses