175A - HP Archive

CRT WARRANTY CLAIM
FROM: DATE:
NAME :
COMPANY:
ADDRESS:
Person to contact for further information:
NAME :
TITLE :
COMPANY:
ADDRESS:
To process your claim quickly please enter the information indicated below:
1) @INSTRUMENT MODEL SERIAL
2) TUBE TYPE
SERIAL
3) OFUGINALTUBE REPLACEMENT TUBE
4) YOUR PURCHASE ORDER NO.
5) DATE PURCHASED
6) PURCHASED FROM
7) COMPLAINT: (Please describe nature of trouble)
8) OPERATING CONDITIONS: (Please describe conditions prior to and at time of failure -
SIGNATURE
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