Part Request Form
Company Name
Street Address
City/State/Zip Code
Contact
Phone
Fax
Purchase Order Number
Call ID #
Model Type
System Configuration Information:
System S/W
Type of failure:
Version
Solid
Intermittent
Problem description (please describe symptoms, error messages and actions taken):
Failed part information:
Part Number:
Warranty
System Serial #
Y
N
Peripherals:
DAT
CD-ROM
Floptical
Other________
Revision:
Date:
RMA#
Closed
(as found on back panel)
Voltage:
Disk (MB/GB)
Memory (MB):
110
220
Date
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this form in its entirety!
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