Return Goods Request Form - Website

Date: 7/31/2010

Reasons for Return

As a responsible partner in the “distribution chain of custody” of medical products, it is appropriate that you assure us that the products you desire to return are not counterfeit, diverted or held under inappropriate temperature and humidity.

The undersigned hereby guarantees that the product(s) being returned (1) have been stored and maintained under manufacturer’s temperature and storage requirements (as indicated on product label, if applicable) while in your possession, (2) have not been transferred to you from another location, (3) were purchased from the McGuff Company, (4) have not been damaged by the manner in which they were handled, or in any other manner, and (5) to the best of your knowledge, are saleable in accordance with applicable laws and regulations.

PLEASE FAX THIS FORM BACK, AFTER SIGNING, TO MCGUFF COMPANY AT 1-714-540-5614 or SCAN SIGNED FORM AND EMAIL TO MCGUFF COMPANY AT Javascript needs to enabled to send email.

Return authorization may not be issued until this form is received by McGuff.

We thank for your time and for your efforts to assure the ongoing security of the drug and device supply chain.

In order to remain in compliance with the most recent Food and Drug Administration interpretation of the Prescription Drug Marketing Act of 1987, State law and Pedigree Requirements, it is required that you complete this form, read your guarantee and, if agreed, print, sign and Fax the statement to McGuff Medical. Credit may not be issued on partially completed forms.

Steps to complete the Return Goods Request Form for authorization to return product:

1. Complete data entry in Parts A. and B.
2. Print this form.
3. Read and sign attestation.
4. Fax or email completed form to McGuff Medical.
5. A McGuff Customer Service Representative will call and arrange for a pickup of the product (we pay for return freight) and provide details on your credit or refund.