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 2) Pump information Pump model: Serial/MFG number: Included with the shipment: Motor Pump head Other: 3) Requested scope Inspection/service Repair Warranty claim Describe the pump problem/failure (important): 4) Cleaning and decontamination Has the pump been drained, cleaned and flushed with water? YesNo Safety data Attach your Safety Data Sheet (SDS): Is the SDS Attached? Yes - pumped media: No - why?: Service cannot start without the SDS 6) Condition of the pump Has the pump been opened or repaired? Yes, describe: No Are parts missing? No Yes, please list: Is there visible damage? No Yes, describe: 7) Service priority Standard Priority Urgent priority (subject to approval) Costs: Approved before repair Repair by invoice Quotation accepted 8) Customers defective parts Defective parts returnedDefective parts disposed 9) Confirmation I confirm that the above information is correct Name Date Confirmation Submit Δ
