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(please, also consider the notes to the next page)
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Company
Customer No.
Contact person/Dept.
Phone
Fax
Postal address
Return to
Invoice No./
Qty.
Item number
Designation
Delivery Note No
Serial number
(please add copy)
>ÕÃiÊvÊÌ iÊV«>Ì
a) Financial complaint
H
wrong delivery
H
variance of quantity
H
________________________________________
b) Technical complaint
Error description
When does the fault occur?
H
permanently
H
temperature dependent
H
sporadic
H
after ___ minutes of operation
Was the item already in use?
H
has not yet been used
H
defect during commissioning
been in use for __ months
Date
Signature