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OP8.3-01 Form Date: 01/14/2004 Rev#: 1
Please select which office you want to send to*:
Your Company Name*:

Customer Number*:
(Upper right corner of our Invoice)
Contact*:
E-mail*:
Telephone*: Ext:
Fax*:

Item No.1 Item No. 2
Item No. as per Invoice: Item No. as per Invoice:
Serial Number: Serial Number:
Invoice No: Invoice No:
Invoice Date: Invoice Date:
Problem: Problem:

Item No. 3 Item No. 4
Item No. as per Invoice: Item No. as per Invoice:
Serial Number: Serial Number:
Invoice No: Invoice No:
Invoice Date: Invoice Date:
Problem: Problem:

Item No. 5 Item No. 6
Item No. as per Invoice: Item No. as per Invoice:
Serial Number: Serial Number:
Invoice No: Invoice No:
Invoice Date: Invoice Date:
Problem: Problem:

Item No. 7 Item No. 8
Item No. as per Invoice: Item No. as per Invoice:
Serial Number: Serial Number:
Invoice No: Invoice No:
Invoice Date: Invoice Date:
Problem: Problem:

Total: Pcs. Notes:

1. Please mark down the problem on masking tape and tape it to each product. Don't write anything directly on the products.
2. Failure in providing proof of purchase or without specifying problem(s) of the returned item(s) will result in the item(s) being returned to sender Freight Collect.
3. No Accessories (Manual, drivers, cables, etc.) except for pre-authorized Credit or DOA.
4. We only perform test as per described on this form. Please be specific.
5. Elco Systems Inc. is not liable for any data lost due to servicing of computer systems.

» A Service Fee of $30.00 per item, plus shipping, will be charged per product found to be non-defective.