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Customer Service Form
Please fill in and return to:
LM-Instruments Oy
PO Box 88 (Norrbyn rantatie 8)
FI-21601 Parainen, Finland
Fax +358 2 4546 444
Customer identification
Dealer name
Contact person
Date
Phone
Address
Email
Fax
Practice name
Contact person
Date of Purchase
Copy of invoice attached
Phone
Address
Email
Fax
List of products for return
Quantity
Product / Part name
Item code and serial no (for
equipment)
For repair or replacement under warranty
For credit under warranty (replacement has already been provided to end customer).
Invoice number:
(Customer Service Form submission within 14 days of invoice date)
For repair outside warranty
Reason for product return/complaint/request
(obligatory)
Description
Please be specific!
The Error Code and Cause Code must be provided for equipment (power scalers, air polishers and
sharpeners as well as their parts).
Contact with charge estimate before proceeding any repairs / replacements outside warranty.
For company use only
RMA-Number
Date of receipt / ref.
Forwarded to
Date
Final report to / by
Date