Heidolph ROTAVAC Vario pumping unit - Manual (Page 60)

page 60 of 61
Documents are only to be used and distributed completely and unchanged. It is strictly the users´ responsibility to check carefully
the validity of this document with respect to his product. Manual-no.: 999248 / 28/04/2011
14 Confirmation of condition of unit
In case of repair
1. Details about the unit
Model _________________________
Serial number _________________________
Reason for repair _________________________
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. Shipper
Name _________________________
First name _________________________
Company _________________________
Department _________________________
Street _________________________
ZIP code _________________________
City _________________________
Country _________________________
Phone _________________________
E-Mail _________________________
5. Legally binding declaration The customer is aware of being legally liable to
Heidolph 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 wellpacked condition, suitable for
the mode of transport.