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Return Authorizations

Please note, Grundfos requires the Date Code (Grundfos PC####), the Install Date and the Fail Date. Please use the Comments section to provide this additional information.

Please provide the following information in order to process your request.

Use a separate form for each manufacturer.
Manufacturer's Info
Manufacturer's Name*
Contact Info
Company Name*
Company City/Branch*
Contact Name*
Email*
Phone
Returns
Number of Returns*
Item 1
Quantity - Item 1*
Part Number - Item 1*
Description - Item 1*
Do you want a replacement? - Item 1*
- Yes
- No
Reason - Item 1*

If the “Reason” is “Defective”, please be more specific in the Comments section below.
Original PO - Item 1*

If this is a purchase order through your Distribution Center (DC), please indicate this in the Comments below.
Date Code / Serial # / Comment - Item 1
Debit # / Reference # - Item 1
Item 2
Quantity - Item 2*
Part Number - Item 2*
Description - Item 2*
Do you want a replacement? - Item 2*
- Yes
- No
Reason - Item 2*

If the “Reason” is “Defective”, please be more specific in the Comments section below
Original PO - Item 2*

If this is a purchase order through your Distribution Center (DC), please indicate this in the Comments below.
Date Code / Serial # / Comment - Item 2
Debit # / Reference # - Item 2
Item 3
Quantity - Item 3*
Part Number - Item 3*
Description - Item 3*
Do you want a replacement? - Item 3*
- Yes
- No
Reason - Item 3*

If the “Reason” is “Defective”, please be more specific in the Comments section below.
Original PO - Item 3*

If this is a purchase order through your Distribution Center (DC), please indicate this in the Comments below.
Date Code / Serial # / Comment - Item 3
Debit # / Reference # - Item 3
Item 4
Quantity - Item 4*
Part Number - Item 4*
Description - Item 4*
Do you want a replacement? - Item 4*
- Yes
- No
Reason - Item 4*

If the “Reason” is “Defective”, please be more specific in the Comments section below.
Original PO - Item 4*

If this is a purchase order through your Distribution Center (DC), please indicate this in the Comments below.
Date Code / Serial # / Comment - Item 4
Debit # / Reference # - Item 4
Item 5
Quantity - Item 5*
Part Number - Item 5*
Description - Item 5*
Do you want a replacement? - Item 5*
- Yes
- No
Reason - Item 5*

If the “Reason” is “Defective”, please be more specific in the Comments section below.
Original PO - Item 5*

If this is a purchase order through your Distribution Center (DC), please indicate this in the Comments below.
Date Code / Serial # / Comment - Item 5
Debit # / Reference # - Item 5
Additional Comments
Comments

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