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 InfoSheet

 

Dear Customer,

Please use this info sheet to inform us you have a problem with / question about one of our products. Try to give us as much information as possible by filling in as many fields as possible. This will make it much easier for us to provide you with the professional assistance you deserve!

Best regards,

Customer Service Team.

 
   
Email-address: *    
CompanyName: *    
  Type of Request: *  
Name of device: *
  Overall Serial Number: * (Not required if it's a "Loan Device Request")
 
  Serial Number Head :  
  Serial Number Console :  
  Serial Number Power Pack/Main Unit :  
  Serial Number Spring Arm :  
  Serial Number Column :  
  Part Number of the item :  
       
Install Date :    
       
  Head Console Main Unit
CPU
FGPA 1
FGPA 2
FGPA 3
  CF Card Software Version  
       
Install location : Hospital Name / Location: *
  Address :
  PostalCode :
  City : *
  Country : *
   
Technical Contact Information : Technical Contact Person :
  Telephone :
  Address :
  Email :
       
After Repair Return Address : Address :
  PostalCode :
  City :
  Country :
       
Error code(s): *



Description of issue/ diagnostic intervention/ visual check: *
Adding Attachments. (If you have more than 5 files to upload, please make a zip-file of them and upload the zip-file.)
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