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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