Claim form

Reden van Retour*

Pick up adress / contact person*

Pick up date + time

Number of boxes / Pallet*

Total Weight*

Dimensions of the boxes/ Pallet*

When applicable Ordernumber (114xxxxxxx) or invoicenumber (414xxxxx)*

Productnumber (s) / Quantity*

Product description

If applicable lotnumber or serialnumber

When did the problem occur?*

In order for us to deal with your claim more thoroughly, please ensure that you enclose some photos of your order/items along with the completed form.

Fisher Scientific customer account number

Title

First name*

Last Name*

Company*

Address*

Zip/postal code*

City*

Country* Austria Belgium Denmark Finland France Germany Ireland Italy Netherlands Norway Portugal Spain Sweden Switzerland United Kingdom

Phone*

Email Address*