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Malfunction Report
Malfunction Report
You can report a malfunction through the form below.
Company name
*
City
*
Visiting address
*
Zip code
*
Country
Department
Title
Sir
Madam
Name
*
Surname
*
Telephone number
*
E-mail
*
Job number
Job number for the purpose of billing
Problem description
*
Please give a detailed description of the defect or problem
Brand equipment
*
Type equipment
*
Serial number equipment
*
Name/room number/location
*
On appointment – call me
Yes
No
During office hours
Yes
No
Preferred date
MM slash DD slash YYYY
Do you have a service contract?
Yes
No
Desired response time
Requesting immediate action without QR contract will result in an extra fee of 136 euro per event.
Immediate action required
Within 5 workdays
Within 10 workdays
Do you request replacement equipment?
Replacement equipment is free of charge with an FS contract
Yes
No