Confirmation Of Condition Of Unit - Heidolph MR Hei-Standard Betriebsanleitung

CONFIRMATION OF CONDITION OF UNIT

Should your instrument require repairs, please complete this declaration and mail or fax it to Heidolph
Instruments GmbH & Co KG
1. Details about the unit
2. Has the unit been cleaned or
decontaminated / sterilized?
3. Is the unit in a condition which does
not represent any health threats for
the staff of our service department?
4. Information about sender
5. Legally binding declaration
Model
Serial number
Reason for repair
submission
yes no
yes no
If not, which substances has the
appliance come into contact with?
Surname, first
name
Company
Department
Street
City, postcode/ZIP
Country
Phone
E-Mail
The customer is aware of being
legally liable to Heidolph Instruments
for any damages arising from
incomplete or incorrect information.
Date
Signature
35
E