| Complaint date: |
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| Sort of instrument: * |
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| Name and type of instrument: * |
e.g. Laura Smart |
| Serial number of instrument: * |
e.g.. 0157 |
| Catalogue code of instrument: |
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| Installation date: |
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| Installed by: |
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| Distributor / User: |
| Company name: * |
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| Address - street, number: * |
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| Address - city, postcode: * |
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| Address - state: * |
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| Address - phone: * |
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| Your e-mail address: * |
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| Distributor name:(if user complaints) |
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| Complaint reason: *(max 508 characters) |
- Write number of error message, faulty part or how the fault or malfunction appears
- If you are the distributor you can define needed spare parts - you have to follow out this specification – catalogue number / name of spare parts / needed number of pieces.
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| Attachments:(max 5 files, max 15MB/file) |
If you have any images, scanned documents, videos etc. attach them here.
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