Zyno Medical LLC
Returned Merchandise Authorization
Customer ID:
1: Company Information
RMA#:
Issued by:
Date Issued:
RMA Requested by:
Company Name:
Return Address:
City/State:
Phone #:
Email:
2: Warranty Information
End User Company:
Contact Name:
End User Address (Street):
City/State:
Phone #:
Email:
PO#:
Under Warranty:
Yes
3: Pump Information
Pump Information:
Serial Number:
Detailed reason for return:
4: Factory Use
Additional Returned Equipment
Power Cord
Warning Light
Clamp
90 Degree
Manuals
Received by:
Received Date:
(Ex: 01/01/1001)
Disposition (check one):
Problem corrected/Pump repaired and shipped back to customer
No problem found. Pump fully tested and shipped back to customer
Pump kept for engineering failure analysis. Sent customer replacement pump (SN:
)
Pump upgraded and shipped back to customer
Other(specify)
5: Company Records
Shipped by:
Date Shipped:
Reviewed by:
Date:
Z-800 Infusion Pump
RMA Form
IV Set Order Form
Training Videos
Introduction
Continuous R/V
Continuous T/V
10 Step Mode
Save a Protocol
Prime and Load IV Tube
Alarms
Lock Keypad
Factory Settings
Interactive Pump Demo
Zyno Medical LLC
Zyno Medical LLC