Instruction manual

K4, K6, K9 series chillers Installation and Operation manual
Issue 10.33
Page 23
In case of repair requirement, please complete both parts of the form, and fax to ATC
Part 1: Returned Material Declaration Form
Returns Number: Q1_ - ___
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:
…………………………………………………