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KJLC® relies on the accuracy and completeness of Customer's answers (indicated above, or attached to this Request) (a) to protect KJLC employees and to comply with applicable laws and (b) to determine whether to issue to Customer an RA# and/or to accept the return goods.
First & Last Name:
Title:
Organization:
Email:
Phone:
Fax:
Street:
City:
Postal/Zip Code:
Country:
State:
* = Required
Reason for Return:
Issue Description: (Minimum 25 character input)
Product Make:
Enter Pump Manufacturer:
Model Name:
Manufacturer Part Number:
Serial Number:
Voltage:
Lubricant:
Enter Lubricant:
Is the pump still under warranty?
Original KJLC Sales Order Number:
Original KJLC Purchase Order Number:
Are the goods in their unopened, original packaging?
No Yes
Irrespective of the goods being opened, have the goods and/or packaging been exposed to any substances (chemicals/gasses/vapors/liquids/solids) other than air?
A.) Please provide complete details of such exposure: (Minimum 25 character input)
B.) Are any of the substances (chemicals/gasses/vapors/liquids/solids) listed above hazardous?
Examples include: Radioactive Materials, Toxic Materials, Biological/Infectious Substances, Corrosive Materials, Carcinogens, Oxidizers, Flammable/Combustible materials, etc.
C.) Please provide complete details of any decontamination efforts that have/will be made: (Minimum 25 character input)
D.) Attach any evidence which supports the attempt of decontamination. (Please keep total uploaded file size for decontamination evidence below 10Mb. Accepted file types include: PDF, JPG and PNG.)
E.) Attach any SDS for each such toxic, hazardous or dangerous chemical and/or material. (Please keep total uploaded file size for SDS below 10Mb. Accepted file types include: PDF, JPG and PNG.)
Rush Service Requested?
By checking the box at the end of this Policy, you confirm that you agree as follows:
Services (if applicable):
Warranty Evaluation (if applicable):
Returns (if applicable):
Miscellaneous (generally applicable):
By checking this box, you agree to be legally bound by the conditions set forth above, including any applicable terms and conditions incorporated by reference.
* * Please scroll through and fully review our Services, Warranty, and Returns Policy * *