Expired Product - Credit Request Form
Submitter Name
First Name
Last Name
Submitter Email
example@example.com
Submitter Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Product Series:
Please Select
OR:06A
OR:11A
OR:12A
OR:14A
UA:06B
UA:10C
UA:13A
UA:16C
UA:17A
UA:18C
Quantisal
How many devices are expired?
Device Lot Number
Device Expiration Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Open the box
Done!
Open each device to obtain the SD Numbers (you will need them later)
Done!
Download, complete, and upload the below linked spreadsheet documenting the SD Numbers:
I understand my credit will not be processed until all required documentation is received.
Download the Excel Template for Submitting SD Numbers
Upload the completed Excel Template here:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Complete one of the following steps:
Take a picture of the open box with the open kits visible. SD Number sheets must be included (mobile devices)
OR
Take a picture of the open box with the open kits visible. SD Number sheets must be included. Upload the photo here:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: