Service Request Optiscan by HC121109064610


									Return address                                  Invoice address
Company Name, Return address                    Company Name, VAT number, Invoice address

Your contact person,                            Your contact person and phone number
phone number, e-mail address

                                                Your purchase order number
Your reference

Product and serial number(s)                    Description of the fault

Other messages                                  Price estimate before starting service
                                                Yes ( )
                                                No   ()
                                                Warranty repair ( )

Service will be carried out and invoiced according to current Optiscan pricing. Please note that creating a
price estimate will be charged at minimum 1 h.

This form should be completed prior to shipping any equipment to enable a rapid response and faster
return of your equipment. Please send this form by e-mail and also attach it to the equipment you are

Repair Center address:

Sweden                                       Finland

OPTISCAN AB                                  OPTISCAN OY
Fagerstagatan 3                              Laturinkuja 2
163 53 Spånga                                02650 ESPOO
Tel. +46 (0)8 632 66 50                      Tel. +358 (0) 9 4766 766
Fax. +46 (0) 8                               Fax. +358 (0) 9 4766 7689
VAT. SE 556268195601                         VAT. FI0758071-4       

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