43
HEADER _______________ (*)
Service Report form
Company name
____________________________________________________
Contact person _______________________________________________________
E-mail address ________________________________________________________
Telephone
__________________________ Fax _____________________
Return address________________________________________________________
Invoicing address ______________________________________________________
Return method
normal
express
Date of purchase ____________________ Type of the device _______________
Hardware supplier______________________________________________________
System Integrator ______________________________________________________
Serial number (*) ______________________________________________________
Software version ______________________________________________________
Fault description of the device (in detail if possible)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Do you wish to have a repair cost estimate before the service (circle appropriate
YES NO
Do you wish to have an express repair (circle appropriate) (**)
YES NO
(**) (if yes, the extra costs will be charged according to the valid service price list)
(continued on next page)
