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220E RETURN SHEET
Company Name
Contact Name
Telephone Number
Approximate Usage (hours)
Problems Encountered
Check One:
Repair
Do you wish to be contacted before repairing
Yes
No
Return
Contact Blastrac if a loaner is needed
Return Authorization Number
Date
Customer Number
Purchased From
required, contact Blastrac
INTERNAL USE ONLY
Date Received
Unit Serial Number
Subject To Warranty
if known
if not directly from Blastrac