XPS-DRVP1
EDH0259En1010 – 08/10
23
Service Form
Your Local Representative
Tel.: ___________________
Fax: ___________________
Name: __________________________________________________
Return authorization #: _____________________________________
Company: _______________________________________________
(Please obtain prior to return of item)
Address: ________________________________________________
Date: ___________________________________________________
Country: ________________________________________________
Phone Number: ___________________________________________
P.O. Number: ____________________________________________
Fax Number: _____________________________________________
Item(s) Being Returned: ____________________________________
Model#: _________________________________________________
Serial #:_________________________________________________
Description:_________________________________________________________________________________________________________
Reasons of return of goods (please list any specific problems): _________________________________________________________________
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