RMA Request Form

General information:
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Customer ID

Company *

Street / No.*

Country*

ZIP Code*

City*

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Technical contact (customer):

Name

Phone

Fax

E-mail

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Commercial contact (customer):
*required fields

Name *

Phone *

Fax

E-mail *

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Contamination declaration:

*required fields YES NO

Are all contaminated goods cleaned?*

Is residual contaminations possible?*

Which substance was in contact with the LinMot parts?*

Which cleaning agents were used?*

Which cleaning method was used?*(e.g. autoclave, neutralisation, desinfection)

Safety data sheets of cleaning agents

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General information:

Customer ID:

Company:

Street/No:

ZIP Code:

City:

Technical contact (customer):

Technical contact name (Technician, involved in troubleshooting):

Technical contact phone:

Technical contact E-mail:

Technical contact Fax:

Commercial contact (customer):

Commercial contact name (e.g. from Purchase. Quality. Logistics):

Commercial contact phone:

Commercial contact E-mail:

Commercial contact Fax:

Item for return:

Item-No.:

Item name *:

Serial number:

Reason for return:

Description:

Contaminations:

Contamination declaration: YES NO

Are all contaminated goods cleaned?

Is residual contaminations possible?

Which substance was in contact with the LinMot parts?

Which cleaning agents were used?

Which cleaning method was used?

Attached files:

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I have read the general RMA information*

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