PAPR Return Form - OTB Products

PAPR Service / Repair Registration Form

IMPORTANT NOTICE:

OTB Products Pty Ltd cannot accept any respirator for service, repair, or warranty replacement, unless the following information has been supplied using the form below:

Name of Company that owns/operates these PAPR Units (supplied confidentially, no contact will be made directly with end user by OTB Products)(Required)

Name of Company Sending these PAPR Units(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Contact Person's Name(Required)

Phone Number(Required)

Email Address(Required)

Quantity of PAPR Units Being Sent(Required)

Select PAPR model(s) being returned - Use Control/Command Click to Select Multiple Items(Required)

PAPR Serial Number(s) & Date of Purchase, If ESM+ Also include Pod Number(Required)

Accessories being returned with the respirator: (batteries, chargers, face shields, etc)

Specific reason for return. Please provide as much detail as possible(Required)

What process(s) PAPR used for(Required)

Specific contaminant(s)

Name of:

Manufacturer of:

Brand name:

By-Product of a process

Please provide Material Safety Data Sheet(s) for contaminant(s)

Drop files here or

Accepted file types: pdf, jpg, jpeg, Max. file size: 50 MB.

Contaminant information(Required)

I understand that respirators without the contamination information attached may be returned to the sender without any further action being taken.

Contaminant Information(Required)

I understand that repirators that have not been thoroughly decontaminated inside and out may be returned to the sender without any further action being taken.

Inspection Charge

I understand that an inspection charge of $95 + GST is applicable to each respirator that is returned regardless of whether a repair and/or service is carried out. Repair/Service costs will be quoted after inspection is completed.

Shipping Details(Required)

I will ship my PAPR unit(s) to: OTB Products, 32/30 Mudgeeraba Road, Mudgeeraba, QLD, 4213

Name of Person Submitting This Form(Required)

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