RMA REQUEST/DECONTAMINATION FORM
DATE: _____________________________________
To Return for Credit or Exchange: Returns must be done within 30 days of invoice date. Full credit is only applied if all items are in original packaging. All
returned products are subject to inspection and approval by Harvard Apparatus prior to credit or replacement. All returns may be subject to a minimum 15%
restocking fee. All returns for credit will be issued to the credit card or purchase order number that was used to place the original order. Some items are not
returnable, including custom orders (98-xxxx catalog numbers). Products not in saleable condition will be returned to customer or a refurbishment fee assessed.
To Return for Repair, Recalibration or Upgrade: Harvard Apparatus will not receive any used products or products requiring repair without a customer’s
signed decontamination form on file. Non-warranty repairs require a credit card or purchase order upon shipping back to the customer. Payment information is
required prior to Harvard returning the unit(s) to the customer. Repair estimates can be provided upon request. If providing payment information prior to repair,
please phone, fax or email a copy of the information to Customer Service/RMA Department 1-800-272-2775 or email to returns@harvardapparatus.com.
1. CUSTOMER INFORMATION:
RMA/Return Order #: ___________________________________
Customer No._______________________________________________________
Return PO # _______________________________
Name _____________________________________________________________
Orig. Order # ______________________________
Institution _________________________________________________________
Orig. PO # ________________________________
Return Ship Address _________________________________________________
Phone ____________________________________
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Fax ______________________________________
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E-Mail ___________________________________
Qty.
Catalog No.
Description
Problem (use back for details)
Serial No.
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2. DECONTAMINATION CHECK:
We will not accept delivery of any equipment that contains or is contaminated with hazardous substances. Please make sure all items are
properly cleaned and decontaminated prior to returning to Harvard Apparatus.Unclean or contaminated items will be rejected and returned
to the customer at the customer's expense. Do not send back any used tubing with your unit.
Decontaminating your equipment can be done by the following methods:
- Gas Sterilization (Ethylene Oxide)
- Irradiation
- Disinfectant Wipe Down (i.e. 10% Bleach Solution),
- Scintillation Count (For radioactive applications. Please include isotope data.)
Your signature below certifies that the equipment has been decontaminated of any hazardous substances.Pease initial the following:
- The returned product is not radioactive _____
- The returned product is not biologically active _____
- The returned product is not dangerous to human health and safety _____
If unit has been internally contaminated due to spillage, please indicate materials spilled: ____________________________________________
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Briefly describe your application, including materials used: __________________________________________________________________
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Signature: ________________________________________________________________
Date: _______________________________
3. REASON FOR RETURN:
Return for Credit
Recalibration / Upgrade
Warranty Repair / Exchange
Non-Warranty Repair / Exchange
Other
Advised Incorrectly
Customer Ordered Incorrectly
Catalog Description Error
Does Not Meet Intended Requirements
Defective or Damaged
Duplicate Shipment
Quality of Product
Order Entry Error
Note: There is a minimum $150.00 evaluation fee on all non-warranty repairs, which will be applied to any repair costs.
Please contact Customer Service at 1-800-272-2775 if you need assistance completing this form. Thank you.
A signed copy of this form must be faxed to 508-429-5732 in order to receive an RMA number.
Detailed Description of Problem:
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Please be advised that the customer is responsible for any damages resulting from improperly packed items. When shipping products back to
Harvard Apparatus for either a repair or credit, it is recommended that you do so in its original packaging to prevent shipping damage. Pumps,
ventilators, med systems, etc. should be placed in a plastic bag after decontaminating before placing in a carton. If you do not have the original
packaging, please contact us for detailed shipping instructions.
Most importantly, provide pumps with adequate bubble wrap around the unit, underneath the unit and on top of the unit so that it is well
cushioned and has no room for movement. Ship only the pump; no tubing please. Unless your pump is having problems with the power
supply, please do not ship the power supply or power cord. Please remove racks from the pumping units before shipping back to us. If the
racks are in need of repair, please package them separately. If they do not require repair, please hold them at your facility. When shipping an INSPIRA ventilator for repair, please remove the cylinders and hold at your facility. If the cylinders are leaking and in need
of repair, send them in a separate box (unless customer has original box) with plenty of bubble wrap. Under no circumstances should customers
ship the cylinders still inside the ventilator as they will be damaged in shipping. Pack the ventilator in bubble wrap with a heavy layer of
peanuts on top and on the bottom to cushion and prevent movement in the box as well. If customers do not have the original Inspira box and
inserts, they should NOT ship the cylinders and ventilator in the same box.
If shipping a 683 or 687 ventilator, please remove the valve if customer does not have original foam packaging.
Please include a copy of the RMA you will receive from us in a window envelope on the outside of the box. Contact Customer Service/RMA
Department if you have any questions regarding shipping your return 1-800-272-2775 or are in need of packing materials (HAI can supply
pump packaging at $15 and ventilator packaging at $25 plus shipping charge).
Rev. A 11/30/07