
FORM TO DELIVER THE INSTRUMENT TO THE PRODUCER / DISTRIBUTOR
MODULO INVIO STRUMENTO AL FABBRICANTE/ DISTRIBUTORE
For the attention of Service Dpt ORUM S.r.l. International
Via Novara 91 20153 Milan, Italy
e-mail: [email protected]
THIS DOCUMENT HAS TO BE DELIVERED TO THE SERVICE DEPARTMENT TOGETHER WITH THE INSTRUMENT
AUTHORIZATION NUMBER……………
COMPANY DETAILS
COMPANY
ADDRESS
CITY / CAP / STATE
PHONE / FAX
E.MAIL
CONTACT NAME
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INSTRUMENT IDENTIFICATION
NAME OF INSTRUMENT, MODEL, SERIAL NUMBER
REASON OF DELIVERY: CALIBRATION / VALIDATION
REASON OF DELIVERY: REPAIR
REASON OF DELIVERY: OTHER (TO BE SPECIFIED)
EXPECTED MALFUNCTIONING
ELECTRONIC PART
ELECTRIC PART
MECHANICAL
PART
NOTES
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NAME
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