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XPS Unified
Service Form
Name: _________________________________________________
Company:_______________________________________________
Address: ________________________________________________
Country: ________________________________________________
P.O. Number: ____________________________________________
Item(s) Being Returned: ____________________________________
Model#: ________________________________________________
Description: ________________________________________________________________________________________________________
Reasons of return of goods (please list any specific problems): ________________________________________________________________
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Return authorization #: ____________________________________
(Please obtain prior to return of item)
Date: __________________________________________________
Phone Number: __________________________________________
Fax Number: ____________________________________________
Serial #: ________________________________________________
707
Programmer's Manual
Your Local Representative
Tel.: __________________
Fax: ___________________
EDH0373En1023 — 01/18
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