WIGGENS WH220-HT
Confirmation of condition of unit
In the case of repair, copy and complete the Conformation of condition of unit and send it to
WIGGENS
Instruments.
1.
Details about the unit
Product number
Serial number
Reason for repair
2.
Has the device been cleaned, decontaminated/sterilized?
Yes
No
3.
Is the unit in a condition which does not represent any health threats for the staff of our service department?
Yes
No
If not, which substances has the unit come into contact with?
4.
Legally binding declaration
The customer is aware of being legally liable to
WIGGENS
Instruments for any damages arising from incomplete and
incorrect information.
Date
Signature
Company stamp
Please Note
The shipper is responsible for the return of the goods in well-packed condition, suitable for the mode of transport.
Sender information
Name
Company
Department, research group Street
Zip code, city
Country
Phone
31
