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Customer number: |
Customer name: |
Contact name: |
Reference number: |
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| In this matter I prefer to be contacted by: |
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Email: |
Phone: |
Fax: |
SCANTECH ID: |
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| Purchase date: |
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| Problem |
| We believe this product is: |
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| We have found the problem in pcs of this product number. |
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| The last year we have purchased appr: pcs of this product number. |
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| Invoice-number/Delivery note: |
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| The problem appears when: |
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Other issues: |
Additional information about the problem:
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Pictures of the product/problem: |
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