Customer Return Form

Please refer to our Conditions of Sale and Returns Policy.

PLEASE PRINT and COMPLETE THIS FORM AND ENCLOSE IT WITH YOUR PRODUCTS. THIS WILL ENABLE HELAPET TO EASILY IDENTIFY YOUR GOODS WHEN THEY ARRIVE. YOU MAY WISH TO KEEP A COPY FOR YOUR RECORDS.

You may download a Word or PDF version of this form by clicking the appropriate icon.

HOSPITAL / COMPANY

DEPARTMENT

NAME

TITLE

PRODUCT

REASON FOR RETURN

YOUR PURCHASE ORDER NO.

HELAPET INVOICE No.

INVOICE DATE

REFUND

REPLACEMENT

Helapet Internal Action

Action

Returned Goods Received

Returned Goods Inspection

Replacement sent

Credit sent

Date
   
    

© 2003-2008 CliniMed (Holdings) Ltd

Form 52
Issue 1

2-Aug-03