SERVICE RETURN CHECKLIST

Please complete this form and attach your Safety Data Sheet before shipping the pump. Pumps wich have processed unknown media or which have not been cleaned cannot be accepted.

1. Customer Information

Company

Contact person

Phone

Email

Return Adress

Country

2. Pump information

Pump model:

Serial/MFG number:

Included with the shipment:
MotorPump headOther:

3. Requested scope:

Inspection/serviceRepairWarranty claim

Describe the pump problem/failure (important):

4. Cleaning and decontamination

Has the pump been drained, cleaned and flushed with water?
YesNo

5. Safety data

Attach your Safety Data Sheet (SDS):

Is the SDS Attached?
YesNo, why?:

Please list media listed in the SDS:

Service cannot start without the SDS

6. Condition of the pump

Has the pump been opened or repaired?
NoYes, describe:

Are parts missing?
No parts missingYes, please list:

Is there visible damage?
NoYes, please describe:

7. Service priority

Standard PriorityUrgent priority (subject to approval)

Costs:

Approved before repairRepair by invoiceQuotation accepted

8. Customers defective parts

Defective parts returnedDefective parts disposed

9. Confirmation

I confirm that the above information is correct
Name

Date

Confirmation
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