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Caframo Return Material Authorization Form

Please submit one form per stirrer and obtain authorization BEFORE shipping. Once received, we will respond to discuss the next steps. Note the "Save and Continue Later" option at the end of the form.
Required Fields*

1. Product Information
Model*
Serial Number*
This stirrer was purchased:*
- New
- Used/pre-owned
2. Reason for Return
Please describe the nature of the problem.*
3. Application
The following sections are to be completed by a person with knowledge of the operation of this stirrer.
Please describe the primary application in which the stirrer is used below.
a. Materials this stirrer has been used to mix and purpose of mixing:*
b. Size, shape, and type of vessel: (eg. 2 L glass beaker, 5 gallon bucket)*
c. Mixing volume(s):*
d. Size and shape of impeller(s):*
e. Speed range:*
f. Viscosity of product:*
g. Duration of operation and frequency:*
h. Any other application information that relates to the stirrer's operation:
Please include a photo or diagram of your mixing configuration.
Drop files here or
Max. file size: 10 MB.
4. Safety
Caframo reserves the right to decline a repair request if it is determined after review to be unsafe for our employees.
For health and safety reasons, the following information must be provided by a person with direct knowledge of the working environment of this stirrer. The service department of Caframo relies on the accuracy and completeness of this information to protect our employees.
a. IMPORTANT: Has this stirrer ever mixed hazardous or harmful materials?*
- Yes
- No
b. Please check all that apply and upload all applicable SDS below.*
- Poisonous Material
- Corrosive Material
- Biological/Infectious Substances
- Flammable/Combustible Material
- Carcinogen
- Radioactive Material
- Oxidizer
- Designated Substance (eg: Isocyanates, Mercury, Lead, Asbestos, Silica...)
- Other
Other hazardous or harmful materials:*
Identify the Designated Substance(s).*
- Acrylonitrile
- Arsenic
- Asbestos
- Benzene
- Coke Oven Emissions
- Ethylene Oxide
- Isocyanates
- Lead
- Mercury
- Silica
- Vinyl Chloride
- Other
Other Designated Substances*
c. REQUIRED: Please upload all applicable Safety Data Sheets, updated within the last 3 years.*
Drop files here or
Max. file size: 10 MB.
d. Please identify the PPE used while stirrer is in operation.*
- Safety Glasses
- Chemical Splash Goggles
- Face Shield
- Disposable Gloves (latex, nitrile)
- Butyl Rubber/Neoprene/Viton Gloves
- Lab Coat
- Apron
- Body Suit
- Dust Mask
- Respirator
- No PPE required
- Other
Other PPE*
e. Please identify the engineering controls used while stirrer is in operation.*
- Industrial hygiene/Handwashing
- Local exhaust ventilation
- Chemical Fume Hood
- Enclosure/Isolation
- No engineering controls required
- Other
Other Engineering Controls*
f. Please specify if your vessel is open or closed. Include the position and distance the stirrer is from the vessel, and any shielding between the vessel and stirrer.*
g. Please identify any additional safety equipment or precautions documented in your facility to keep workers safe when working with the materials identified above.
5. Customer Information
Company Name*
Name*
First Last
Position
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Are you located within the United States?*
- Yes
- No
Federal ID*
(US locations ONLY, number format XX-XXXXXXX)
6. Shipping Information
Is your shipping information different from above?*
- Yes
- No
Name
First Last
Company Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Position
Phone
Email
7. Cleaning Validation
Stirrers must be cleaned before return to Caframo for servicing.
The following sections are to be completed by a person with knowledge of the cleaning procedure for this stirrer. For prompt review, please complete the required fields below:
a. Please describe the cleaning procedures taken to prepare this stirrer for return to Caframo.*
b. REQUIRED: After cleaning as described above, please disinfect all external surfaces with isopropyl alcohol (IPA) and upload photos of the cleaned stirrer.*
Drop files here or
Max. file size: 10 MB.
IMPORTANT: Please click the following box to confirm the above information has been provided by a person with knowledge of the stirrer's working environment.*
- "I hereby digitally authenticate this submission."
Name
This field is for validation purposes and should be left unchanged.

Save and Continue Later

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Caframo Return Material Authorization Form

1. Product Information

2. Reason for Return

3. Application

4. Safety

5. Customer Information

6. Shipping Information

7. Cleaning Validation

A collection of our most popular products.

Delivering safe, reliable products since 1955.

News

Service & Support

Find a Distributor