Past Due Pre-Ship

Dear Gyrus ACMI Customer:

Contact Person: paul lewis

Account: 82411
Customer: VA MEDICAL CENTER
PO BOX 149971 AUSTIN TX US 78714

Thank you for your recent order under the Repair/Exchange Program. We trust that your order has been filled properly.

In order for Gyrus ACMI to continue providing customers with a Repair/Exchange Program, it is imperative that we receive your broken instrument within
the allotted 10-day period. Failure to meet this requirement will result in an additional billing to your account. Our records indicate your damaged unit
has not yet been received.

Please contact the Repair Administration Department at 1-888-524-7266 to make arrangements as to when the receipt of your damaged instrument can
be expected.

Please reference Return Authorization Number, when returning your damaged unit.

Sincerely,
GYRUS ACMI

RMA_NUMBER Model # Reference PO# Pre Ship Date Serial #

50026637 M3-30A PO88787887 03-SEP-2010 009090

Return to the following address:

Gyrus ACMI
93 North Pleasant Street
Norwalk, Ohio 44857

**REPAIRS ONLY**- Following the regulations of the OSHA Bloodborne Pathogen Standard 29 CFR 1910.1030, all
medical devices returned to ACMI for any reason must be decontaminated (cleaned, disinfected, and/or
sterilized) according to the Operating and Maintenance Manual for that device.
To expedite your service request, please complete this form and enclose with your instrument. Failure to include cleaning
and disinfection and/or sterilization documentation will delay your repair. ACMI is dedicated to the safety of our customers,
shipping partners and employees.
The accompanying medical equipment has been cleaned ____ (initial) and disinfected, or sterilized _____ (initial)
prior to shipment.

______________________________________________
Signature Date

Customer Notes:

ACMI RETURN POLICY:

All returns for credit, repair or warranty review must have prior written authorization from ACMI before shipment. Merchandise returned for credit with proper return
authorization (RA) prominently displayed on the box, unopened and undamaged in original package within thirty (30) calendar days of invoice date shall be
credited in full. After 30 days, ACMI will only accept merchandise returned with proper RA identification, unopened and undamaged in the original packaging, up to
90 days from the invoice date, at 80% credit (20%restocking charge). All sales over 90 days from invoice date are considered final.
ACMI reserves the right to refuse, return collect or charge the customer appropriate refurbishment fees for merchandise returned without prior return authorization
prominently displayed, all sales beyond 90 days, and/or any product that has been damaged, opened or returned in inappropriate packaging. Product damaged in
transit is the responsibility of the customer.
Sterile products with broken seals, over labeling, special/custom devices, lamps, and obsolete merchandise not listed in the current Price List Edition are not
returnable.

THANK YOU FOR YOUR BUSINESS!