Product Reclaim Form

Product Reclaim Form

Parties and Recitals

THIS PRODUCT RECLAIM FORM (the "Form") is entered into between Claimant: and Reclaimer: .

WHEREAS, Claimant seeks to reclaim certain products previously sold, delivered, or otherwise transferred to Reclaimer; and

WHEREAS, Reclaimer has a formal reclaim process that governs acceptance, inspection, repair, disposal, credit issuance, or replacement of reclaimed products; and

WHEREAS, the parties wish to document the reclaim request, the scope of reclaim actions, associated financial adjustments, and mutual obligations in accordance with the terms set forth below.

Claimant and Contact Information

Product Details (List each item to be reclaimed)

Item 1 — Description: Serial/Batch #: Quantity:

Item 2 — Description: Serial/Batch #: Quantity:

Original Invoice/PO #: Original Purchase Date: RMA Requested:

Reclaim Reason and Handling Options

Select reason(s) for reclaim:

Defective upon receipt    Warranty claim    Wrong item shipped    Obsolete / Return for disposal

Requested handling (select one or more): Repair    Refurbish    Credit/Refund    Replace    Dispose with certification

Payment Terms

Refund/Credit Amount (if approved): $    Restocking or Handling Fee: $

Late payment on agreed refunds or charges shall accrue interest at a rate of compounded monthly, or the maximum allowable by law, whichever is lower.

Term and Termination

Reclaim Start Date:    Expected Completion/Acceptance Date:

Either party may terminate this reclaim request upon written notice of days to the other party. Termination does not relieve Claimant of liability for costs incurred prior to termination, including inspection, handling, testing, and disposal fees as documented by Reclaimer.

Inspection, Acceptance, and Remedies

Reclaimer shall inspect reclaimed items upon receipt and shall provide an inspection report within days. Acceptance is contingent on inspection. Approved remedies may include repair, replacement, credit, or disposal as expressly documented in an approval notice signed by an authorized representative of Reclaimer.

Confidentiality

Each party shall keep confidential and shall not disclose to any third party any proprietary or technical information provided in connection with the reclaim, except as required by law. Confidential information does not include information that (i) is already known to the receiving party without restriction; (ii) becomes publicly known through no fault of the receiving party; or (iii) is rightfully received from a third party without breach of an obligation of confidentiality.

Warranties and Limitation of Liability

Reclaimer warrants that any repair or refurbishment will be performed in a commercially reasonable manner. Except as expressly stated in writing, Reclaimer makes no other warranties, express or implied. To the fullest extent permitted by law, neither party shall be liable for consequential, incidental, or special damages arising out of this reclaim process.

Governing Law and Entire Agreement

This Form shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles.

This Form, together with any written approvals and inspection reports issued hereunder, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements, understandings, and representations, whether written or oral.

Certifications and Authorizations

By submitting this Form, Claimant certifies that the information provided is complete and accurate to the best of its knowledge and that Claimant is authorized to request reclaim of the items listed. Claimant authorizes Reclaimer to inspect, test, repair, refurbish, dispose of, or credit the reclaimed items in accordance with the scope defined above.

I certify the foregoing and agree to the terms and conditions contained herein.

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