Returned Goods Form

To return items, complete this form and submit it. Fields marked * are required. To return more than 20 product lines, please email sales@oxylitre.co.uk.

Customer Information

Return Codes

Use these codes in the Return Code column below: A Repair B Warranty C Complaint D Incorrect Item E Other (describe in the Suspected Fault column).

Returned Products

See Decontamination Requirements below. Enter how many product lines you are returning, then complete the rows.

Number of products to return (1–20) *

#	Product Code	Units S/N	Return Code	Suspected Fault (if applicable)
Enter a number above to generate product rows.

Decontamination

The MHRA Device Bulletin DB 2006(5) requires decontamination status to be supplied with goods returned for repair or service.

How will decontamination be documented?

Complete the details below. These are required when using this form to record decontamination.

I confirm all devices listed above have been decontaminated and are safe to handle. *

By submitting, the named person above confirms responsibility for the decontamination details provided.

Returned Goods Form