MAN 06-0015A
Please make a copy of this page, fill it out and send to Ziehm imaging, Inc. within two (2) weeks of equip-
ment installation. May mail or fax as instructed below:
Mail:Ziehm Imaging, Inc., Attention: Service Dept.,
4181 Latham Street,
Riverside, CA 92501
Fax: 909-781-6457
If you have any questions, call: 909-781-2020.
Equipment: Installation Date:
Model Number: Serial Number:
Final Destination:
Street Address:
City / State / Zip Code
Contact Person:
Phone Number:
Dealer:
Street Address:
City / State / Zip Code
Contact Person:
Phone Number:
Ziehm Imaging, Inc., 4181 Latham Street, Riverside, CA 92501
FDA Equipment Locator Card