Trial Equipment Request Form

Contact:

Please include area code.

 a.  You are the authorised primary point of contact for your facility regarding this clinical trial.

 b.  Hipac reserves the right to charge your organisation for any loss or damage to trial equipment that occurs during the trial period.

 c.  You will organise the return of the trial equipment 14 days from the day of receipt unless otherwise agreed upon with your designated Hipac contact person. All returns must be accompanied with a Goods Return Authorisation form which can be sourced here.

 d.  Submission of this form does not automatically approve a clinical trial on behalf of Hipac. A company representative will make contact following receipt of this form and Hipac reserves the right to cancel any clinical trial at its own discretion.

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