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Last Name *

Company Name (If Applicable)

Email *

Phone *

Address *

City *

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State *

State/Province/Territory

Zip/Postal Code *

Ship to Same Address

Shipping Name *

Shipping Address *

Shipping City *

Shipping Country *

Shipping State *

State/Province/Territory

Shipping Zip Code *

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Reason For Sending *

Explanation

Converter Part Number *

Converter Serial Number *

WHERE TO FIND PART/SERIAL NUMBERS

Part Number:

Serial Number:

Additional Information

Upload Datalog or Pictures?

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Pictures

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Supported format: JPG, JPEG, PNG, GIF, SVG.

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Following completion of the form, you will receive an email confirmation with a Return Authorization Number enclosed.

Please print a copy of the confirmation email and include in the package of the return shipment while following any instructions or guidelines outlined in the confirmation.

General Pricing and Lead Times:

HP Series Single-Disk Converter Service: $400

Pro Series Single-Disk Converter Service: $450

Pro Series Triple-Disk Converter Service: $500

10 Speed Converter Service: $550

Current Lead Time: 7-10 Business Days (following receipt of the unit at our facility). Any changes to the converter will increase this turnaround time.

Circle D Specialties - dealer APplication form