35
E
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
Model
Serial
number
Reason for repair
submission
2. Has the unit been cleaned or
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
appliance come into contact with?
4. Information about sender
Surname,
first
name
Company
Department
Street
City,
postcode/ZIP
Country
Phone
5.
Legally binding declaration
The customer is aware of being
legally liable to Heidolph Instruments
for any damages arising from
incomplete or incorrect information.
Date
Signature
