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Francaise, Confirmation of condition of unit, 4 confirmation of condition of unit – Heidolph Rotacool Mini User Manual

Page 41

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Appendix

1.01

Rotacool mini

39

9.4 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 (see chapter 7.4, page
35).

1.

Details about the unit

Model

Serial number

Reason for repair
submission

2.

Has the unit been cleaned or de-
contaminated / 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

E-Mail

5.

Legally binding declaration

The customer is aware of being
legally liable to Heidolph Instruments
for any damages arising from in-
complete or incorrect information.

Date

Signature