| About the reported monitor |
| Model * |
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| Panel type |
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| Serial number (S/N) * |
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| Color of chassi |
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| Used time (hours) |
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| Purchase date |
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| Is the reported monitor one from a purchased pair (only valid for RadiForce) |
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| If Yes |
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| Pairing number |
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| S/N, second unit |
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| Eizo authorized distributor/customer (invoicing address) |
| Company name/Name |
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| Contact person/department |
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| Distributors ref no. |
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| Address |
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| PO box |
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| Postal code |
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| City |
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| Country |
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| Org. reg. no. |
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| VAT no./Tax ID |
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| Telephone * |
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| Mobile phone |
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| Fax |
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| E-mail address * |
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| User/delivery address (if other than invoicing) |
| Company name |
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| Contact person/department |
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| Address |
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| Postal code |
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| City |
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| Country |
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| Business hours |
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| Telephone |
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| Mobile phone |
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| Fax |
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| E-mail address |
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| Requested service |
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| Requested freight type |
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| Requested freight level |
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| About the trouble (tick problem type or describe symptoms) |
| Does the product show an image |
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No
Indicator light is:
Blue
Green
Yellow
Blinking
Off
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Yes
Detailed fault description:
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| Is the fault description verified by an authorized Eizo distributor |
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| Problems appear at |
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| Problems appear |
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With ANALOG video (VGA)
With DIGITAL video (DVI)
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Constantly
Sometimes, how often:
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| Is the product marked against theft * |
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| Is the product damaged * |
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NB! Eizo Nordic AB will charge for the repair (including labour and material) of any flaws, defects or damages not covered by the limited warranty on trouble reported products returned after single SWAP. To avoid this cost Eizo Nordic AB offers Temporary SWAP, Pick Up or Send-in service. This applies for example to: Theft marking, Freight damage, Lightning damage, Scratches on casing/screen surface or Discolouration of casing due to e.g. smoking, sunlight, etc. |
Eizo Nordic AB reserves the right to charge:
- If the trouble reported product has flaws, defects, damages, etc. that not are covered by the limited warranty
- For work expenses upon troubleshooting and for freight costs if trouble reported product should prove to be free of defects
- For the replacement product if the trouble-reported product does not arrive at Eizo Nordic AB within 10 days of delivery of the replacement product. Return of the trouble-reported product after more than 10 days of invoice date is not accepted
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| I do declare that the information filled in above is true & correct and that I have read, understood and accept the terms above * |
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If some information is missing or not correctly filled in, the service might be delayed. If you are unable to complete the obligatory * or accept the terms, please take contact to Eizo Nordic AB. |
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Please fill in all fields marked with a red asterisk
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