AREMDE NEXUS - Warranty Request Form; Customer Information; Equipment Details; Description of Fault

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14.0 WARRANTY REQUEST FORM
CUSTOMER INFORMATION
Name: ...............................................................................
Phone: ...............................................................................
Email: ...............................................................................
Address: .....................................................................................
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EQUIPMENT DETAILS
Machine Model: ..................................................................
Machine Serial Number: .......................................................
Manufacture Date: .......................................................................
Invoice Date: ................................................................................
DESCRIPTION
Faulty Part Number And Description: .....................................
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Failure Date: .......................................................................
Machine Fault: .............................................................................
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I hereby declare that the information provided in this form is true and correct and to the best of my knowledge and I have complied with all the conditions of the warranty.
Name: ...............................................................................
Signed: .............................................................................
Date: ................................................................................
Ofce Use Only: ...........................................................................
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Please note that incomplete forms will not be processed. Completion of this form does not constitue an admission of liability by Aremde