Repair Request Form

Contact Overview

Contact Information

Billing Address

Shipping Address

Safety Service Form

A separate Safety Service Attachment needs to be completed for every single item. This Safety Service Form is legally binding and can ONLY be completed by an authorized and qualified staff member.

Welch vacuum pumps are often used in laboratory applications that could involve contact with dangerous chemicals. The overriding concern in operating, maintaining, or repairing equipment in the laboratory environment is always for safety – safety for all personnel who could potentially be exposed to chemical contamination. When sending a pump in for repair, keep in mind the safety of shipping and repair personnel.

  1. As a first step toward reducing potential hazards, always clean and decontaminate pumps per the procedures on the Welch safety form prior to shipment.
  2. Additionally, Welch (and the law) requires full disclosure of potential contaminants on the Safety Service form to be provided prior to issuing a return authorization. The information on this form will dictate the handling needed in the repair process and is vital to the safety of our workers. We appreciate your cooperation on this.

Product Information

Explanation of Problem

Warranty / Sales Status

Decontamination Procedure

for Direct & Belt Driven Pumps
  1. Flush Pump Three Times. Drain pump completely. Refill with fresh vacuum oil. Operate pump blanked off for at least 15 minutes. Repeat all steps two more times. Drain completely. Oil should come out clean, otherwise repeat until clean.
  2. Additional Cleaning Requirements:

For Everyone's Safety

Please answer the questions below completely, and send MSDS when there is a box checked Yes. If this is not done, a RETURN NUMBER will not be issued.

Legally Binding Declaration

I/we Hereby declare that the information supplied on this form is accurate and sufficient to judge any contamination level.

Terms and Conditions

  • There is a 90 day warranty on all repair items.
  • Price is subject to change upon inspection.
  • Customer will be notified for approval prior to any changes besides the fixed rate.
  • Warranty repair only upon inspection.
  • If shipping damage occurs, customer should file claim with shipping company.
  • Inspection fee for all non-warranty items is $150.00.
  • Non-warranty items customer must pay all freight charges.
  • Warranty items customer pays freight incoming and Welch pays freight outgoing.