Notification of defect

Date and time of notification:

Customer's reference number:
(number of repair...) **

Client (Name of company):

Branch office:

Address: *

VAT: *

Name of contact person:

Telephone:

Mobile phone: *

Fax: *

E-mail:

Name of user:

Phone:

Building, Room:
(address of location of device)

Who to contact during repair:

Contact person:

User:

Type of device:

Serial Number of device:

Type of periphery, monitor: **

Serial Number of periphery, monitor: **

Operating system:

Other periphery:
(if related to defect)) **

Brief description of defect: (+systems reports, error codes, etc.)

Seller: *

No. of invoice or delivery note: *

Date of purchase: *

Required type of repair: ** Warranty After warranty Not known

Required place of repair: In service On site

Proposed term of repair: **

Date:

from:

to:

Time:

from:

to :

Opište číslo: '115806' *

* Optional for Infinity a.s. customers

** Optional for all