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

Number of items to return*
- 1 Item
- 2 items
- 3 items
- 4 items
- 5 items
Name*
First Last
Company Name*
Address*
Address where you desire to receive the goods after repair
Post Code*
Nationality*
Contact Telephone*
Please, specify direct no. or extension no.
Fax Number
Email*

Contact person email address
*
- I have read and accepted the privacy policy
We inform you that the personal data contained in this document, including contact information, are protected in accordance with the General Data Protection Regulation (2016/679) and other current legislation regarding the protection of personal data. The process owner is IUL, S.A. and will process your data to manage the relationship with your customers, suppliers and business contacts. The data provided will be kept while the commercial relationship is maintained, during the years necessary to comply with the legal obligations or until they cease to be necessary for the purpose for which they were collected. The information provided through the contact request forms can be communicated to our local distributors so that they can attend your request. Otherwise, the data will not be transferred to third parties except in cases where there is a legal obligation. You can request at any time access to your personal data, as well as rectification, opposition, cancellation, portability or oblivion. For this you should be addressed to IUL by mail to Carrer de la Ciutat d’Asunción, 4, 08030 Barcelona, or by email to iul@iul-inst.com.

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.