Product return form


Customer informations
Company
Address
Contact
E-Mail
Telephone
Fax
Products informations
Your order No. Ordered q.ty
Bill No. Defective q.ty
End user Returned q.ty
NUOVA FIMA code or model
Product description
Problem description

Operating conditions
Pressure Temperature
Vibrations Press.pulsations
Ambient conditions
Operative time

Not dangerous product return declaration

Process medium (product was contaminated with the followings chemical products)

Hazard classification

Requested action

Documents for information (dim. < 500 kb)
Attachment 1
Attachment 2
Attachment 3