Edwards EV1000A

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URGENT FIELD SAFETY NOTICE –
FCA #128
EV1000
Model Numbers: EV1000A, EV1000NI
Lot Numbers: All lots for models listed
CUSTOMER ACKNOWLEDGEMENT
<Customer #>
<Firm Name>
<Attention: RISK MANAGEMENT>
<Address>
<City/state/zip>
Please follow all instructions below to complete the acknowledgement process.
Complete this acknowledgement form with the following information:
 DO NOT return any product
 Verify your inventory and correct setup of the system
 Complete all sections of the table below, indicate “0” if you have no product
 Fax/e-mail the completed form to Edwards Customer Service or Tech Support at
<phone>, within 10 days from receipt of this notification
 A follow-up communication will be sent with further instructions.
Model
Serial
Number
Ship To Date
Quantity
Shipped
From EW
Number of
Units on hand
Name (Print):
Title/Dept.
Telephone Number:
Signature:
Date:
Please return this form via fax to Edwards Customer Service or Tech Support at: <phone>