BioLogic BIODOM 27A - Page 6

DEVICE INSTALLATION (TO BE COMPLETED BY THE INSTALLER'S COMPANY)
Date of installation
Name of installer's
company
Address, postal code
Tel. no. MOBILE
E-mail address
Name, surname of
installer
Serial number
Stamp and signature
of installer
Special features:
STARTING THE DEVICE (TO BE COMPLETED BY AN AUTHORISED SERVICE COMPANY)
Launch date
Name of authorised
service company
Address, postal code
Tel. no. MOBILE
E-mail address
Name and surname
of service technician
Serial number
Stamp and signature
of service technician
Special features: