0 return of setra systems product-declaration – Setra System Model 760 User Manual
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11.0 RETURN OF SETRA SYSTEMS PRODUCT-DECLARATION
(Form 760ERN)
EXPECTED RETURN NUMBER _____________________________________________
You must:
•
Know about all of the substances which have been used and produced in the product before you complete this
Declaration.
• Contact your supplier if you have any questions and for an ERN Number.
• Send this form to your supplier with the return of the product.
SECTION 1: Product
A. Model Number ________________________
B. Serial Number ________________________
C. Has the product been used, tested or operated?
❏ Yes - Go to Section 2
❏
No - Go to Section 4
SECTION 2: Substances in Contact with the Product
A. Radioactive*
❏
Yes ❏ No
B. Biologically Active
❏
Yes ❏ No
C. Dangerous to Human Health and Safety?
❏
Yes ❏ No
* Note: Your supplier will not accept delivery of any products that are contaminated with radioactive substances,
unless you:
• Decontaminate the products
• Provide proof of decontamination
YOU MUST CONTACT YOUR SUPPLIER FOR ADVICE BEFORE YOU RETURN SUCH PRODUCTS
If you have answered “no” to all of these questions, go to Section 4.
SECTION 3: List of Substances in Contact with the Product
SECTION 4: Return Information
Reason for return and symptoms of malfunction: _________________________________________
______________________________________________________________________
If you have a warranty claim:
• Who did you buy the product from?: _______________________________________________
• Give the supplier’s invoice number or your purchase order number: _____________________________
SECTION 5: Declaration
Print your Name: __________________________ Print Your Job Title: ____________________
Print Your Company Name: ______________________________________________________
Print Your Address: ___________________________________________________________
Telephone Number: ________________________ Date of Product Return:__________________
I have made reasonable inquiry and I have supplied accurate information in this Declaration. I have not withheld any
information. I have followed the Return of Setra Systems Product Procedure.
Signed: ________________________________ Date: _____________________________
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