SMI Failure Analysis Service
Request Form

Please complete the form below, then print and fax it to SMI at (630) 495-8595.

Or you can e-mail your request to luke@smihq.org.
(Please include all pertinent information, as outlined below.)

I am interested in the SMI failure analysis service. Please contact me to discuss specifics, and provide me with a test plan and quote.
Person to contact :
Company :
Address :
City: ____________________________ State/Province:___________Postal Code:
E-mail:
Telephone: ________________________________________ Fax:

Type of component that failed:

_

Material type and related specifications:

Material size:
Describe failure:

_

Describe operating conditions:.

_

_
Limitation of liability: By signing this form, I agree that, under no circumstances and in no event will SMI or its staff, partners or vendors be liable to me or any other person or entity for any damages, including actual, direct, indirect, special incidental or consequential damages, and including but not limited to lost profits or assets resulting from the failure analysis service.

_____________________________________________________________________
Signature_____________________________________________________________ Date
Please fax this form to (630) 495-8595

Questions? Please call (630) 495-8588

Springs should be sent to Luke Zubek at the SMI office
2001 Midwest Road, Suite 106, Oak Brook IL 60523-1335
Failure Analysis will not be performed until this form is signed and returned.

Home  Services Failure Analysis