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Serial Number
*
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Model Number
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Hospital Name
*
Address
*
City
*
State
Contact Name
*
Contact Email
*
Contact Phone
*
Current Location of Unit
*
e.g. Engineers department.
Description of Symptom(s)
Describe all the symptoms the bed/stretcher is displaying.
Description of Fault if known
Describe all the symptoms the bed/stretcher is displaying.
If the symptom is an electrical fault, has a reset been completed
- None -
Yes
No
N/A
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Terms and Conditions
*
I have read and understood Howard Wright Limited's warranty policy.
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