Return of Merchandise Authorization

1 Contact Information

2 Case 1 description

3 Case 2 description

4 Case 3 description

5 Case 4 description

6 Case 5 description

OQ Requested
- Request OQ
Mark this only if you request the Operation Qualification document after repair
Quotation Requested
- Request quotation
Mark this only if you request a quotation in the event your product warranty expired or it is not applicable
Cat. No.*
Material / Product Catalogue Number
Serial No.
All instruments and some instruments parts
Lot No.
Only products with expiry date. Specify all numbers in the box. If more than one Lot. No. Write all.
Mains
Voltage (V)
Case Description*
Detailed description of the problem. Description may include detailed workflow and step of the operation when the problem ocurred.
Instrument Error Message
If any Error Message displayed on the instrument screen at the moment of the instrument malfunctioning. Write ALL information displayed on the screen.',CAPTION,'Instrument Error Message
Describe if the problem randomly ocurs or if it always occurs when performing the same operation over and over again.
IUL, S.A. Sales Order Number.
Customer's Purchase Order Number
Additional information
Upload File

OQ Requested
- Request OQ
Mark this only if you request the Operation Qualification document after repair
Quotation Requested
- Request quotation
Mark this only if you request a quotation in the event your product warranty expired or it is not applicable
Cat. No.*
Material / Product Catalogue Number
Serial No.
All instruments and some instruments parts
Lot No.
Only products with expiry date. Specify all numbers in the box. If more than one Lot. No. Write all.
Mains
Voltage (V)
Case Description*
Detailed description of the problem. Description may include detailed workflow and step of the operation when the problem ocurred.
Instrument Error Message
If any Error Message displayed on the instrument screen at the moment of the instrument malfunctioning. Write ALL information displayed on the screen.',CAPTION,'Instrument Error Message
Describe if the problem randomly ocurs or if it always occurs when performing the same operation over and over again.
IUL, S.A. Sales Order Number.
Customer's Purchase Order Number
Additional information
Upload File

OQ Requested
- Request OQ
Mark this only if you request the Operation Qualification document after repair
Quotation Requested
- Request quotation
Mark this only if you request a quotation in the event your product warranty expired or it is not applicable
Cat. No.*
Material / Product Catalogue Number
Serial No.
All instruments and some instruments parts
Lot No.
Only products with expiry date. Specify all numbers in the box. If more than one Lot. No. Write all.
Mains
Voltage (V)
Case Description*
Detailed description of the problem. Description may include detailed workflow and step of the operation when the problem ocurred.
Instrument Error Message
If any Error Message displayed on the instrument screen at the moment of the instrument malfunctioning. Write ALL information displayed on the screen.',CAPTION,'Instrument Error Message
Describe if the problem randomly ocurs or if it always occurs when performing the same operation over and over again.
IUL, S.A. Sales Order Number.
Customer's Purchase Order Number
Additional information
Upload File

OQ Requested
- Request OQ
Mark this only if you request the Operation Qualification document after repair
Quotation Requested
- Request quotation
Mark this only if you request a quotation in the event your product warranty expired or it is not applicable
Cat. No.*
Material / Product Catalogue Number
Serial No.
All instruments and some instruments parts
Lot No.
Only products with expiry date. Specify all numbers in the box. If more than one Lot. No. Write all.
Mains
Voltage (V)
Case Description*
Detailed description of the problem. Description may include detailed workflow and step of the operation when the problem ocurred.
Instrument Error Message
If any Error Message displayed on the instrument screen at the moment of the instrument malfunctioning. Write ALL information displayed on the screen.',CAPTION,'Instrument Error Message
Describe if the problem randomly ocurs or if it always occurs when performing the same operation over and over again.
IUL, S.A. Sales Order Number.
Customer's Purchase Order Number
Additional information
Upload File

OQ Requested
- Request OQ
Mark this only if you request the Operation Qualification document after repair
Quotation Requested
- Request quotation
Mark this only if you request a quotation in the event your product warranty expired or it is not applicable
Cat. No.*
Material / Product Catalogue Number
Serial No.
All instruments and some instruments parts
Lot No.
Only products with expiry date. Specify all numbers in the box. If more than one Lot. No. Write all.
Mains
Voltage (V)
Case Description*
Detailed description of the problem. Description may include detailed workflow and step of the operation when the problem ocurred.
Instrument Error Message
If any Error Message displayed on the instrument screen at the moment of the instrument malfunctioning. Write ALL information displayed on the screen.',CAPTION,'Instrument Error Message
Describe if the problem randomly ocurs or if it always occurs when performing the same operation over and over again.
IUL, S.A. Sales Order Number.
Customer's Purchase Order Number
Additional information
Upload File
Name
This field is for validation purposes and should be left unchanged.