Your Contact Information

Title:

First Name: *

Last Name: *

Position:

Institution:

Department:

Phone:

Fax:

Email: *

Shipping Address for Repaired/Returned Product

Shipping Address:

Shipping Address 2:

Shipping City:

Shipping State (for customers in the USA or PR):

Shipping Province (for customers in Canada):

Shipping Zip / Postal Code:

Shipping Country:

Billing Information for Repaired/Returned Product

Billing Address:

Billing Address 2:

Billing City:

Billing State (for customers in the USA or PR):

Province (for customers in Canada):

Billing Zip / Postal Code:

Billing Country:

Order Information - please provide one of the numbers below

Invoice Number:

Packing Slip Number:

Sales Order Number:

Purchase Order:

Item 1

Name:

SKU: *

Quantity:

Under Warranty:

Issue: *

Item 2

Name:

SKU:

Quantity:

Under Warranty:

Issue:

Item 3

Name:

SKU:

Quantity:

Under Warranty:

Issue:

Decontamination Check

We will not accept delivery of any equipment that contains or is contaminated with hazardous substances. Please make sure all items are properly cleaned and decontaminated prior to returning to our facility.

Decontaminating your equipment can be done by the following methods:

Gas Sterilization (Ethylene Oxide)
Irradiation
Disinfectant wipe down (i.e. 10% Bleach Solution)
Scintillation count (For radioactive applications. Please include isotope data.)

Please mark the following check boxes to confirm that your return is safe to handle.

Hazardous Material:

The returned product is not radioactive.

The returned product is not biologically active

The returned product is not dangerous to human health and safety.

NOTE: Not checking the boxes may cause that an RMA number assignment not to be issued