Instruction manual

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KT series chillers – Installation and Operation manual

Issue 7.0 Page 20

In case of repair requirement, please complete both parts of the form, and fax to ATC

PART 1: RETURNED MATERIAL DECLARATION FORM

Returns Number: Q0_ - ___

Your Name and Address:

…………………………………………………

Your purchase order number:

…………………………………………………

Machine part number:

Machine serial number:

…………………………………………………

Collection for return to ATC – please tick one:

ATC to arrange shipment

Customer to arrange shipment

Reason for return:

…………………….………………………………………………………………………….

If faulty, list symptoms:

…………………….………………………………………………………………………….

Address for delivery of machine

(if different from 1, above):

…………………………………………………

Please note that a minimum non-refundable inspection fee of £60 will be charged on all equipment returned for repair with the exception of equipment still under warranty.

PART 2: HEALTH & SAFETY DECLARATION

Machine part number:

…………………………………………………

Machine serial number:

…………………………………………………

I, ……………………., of ……………………………………., confirm that the above unit

is free from chemical, biological or nuclear hazard and that the unit presents no physical

hazard, including electrical.

Signed and dated:

…………………………………………………