BEEHIVE SUPER BEE - Page 6

BEEHIVE MEDICAL ELECTRONICS, Inc.
870 West 2600 South• Box 19244 •Salt Lake City, Utah 84120 • C801J 487-0741 •TWX 910-925-5271
MALFUNCTION REPORT
Dear Customer:
We are trying to manufacture the most reliable product possible. You
would do us a great courtesy by completing this form should you
experience any failures.
1. Type Unit Serial No.
~~~~~~~~~~~~~~~~ -~~~~~~-
Module (if applicable)
~~~~~~~~~~~~~~~~~~~
2. Part failed (Name and Number)
~~~~~~~~~~~~~~~~~
3. Cause of failure (If readily available)
4. Approximate hours/days of operation to failure
~~~~~~~~~~
5. Failure occurred during:
Final Inspection Customer Installation Field Use
6. Personal Comment:
Address
~~~~~~~~~~~~~~~~
Signed
~~~~~~~~~~~~~~~~~
Date
~~~~~~~~~~~~~~~~~-
Beehive Medical Electronic~, Tnc.
c/o Field Service Department
870 West 2600 South
P.O. Box l 9244
Sa It Lake City, ll tah 84120