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FAILURE NOTIFICATION FORM
 
   * Date of Failure Notification
   * Name
     Company
   * Phone
  E-Mail
  Address / Province
  Message
     
Devices and Failure Information
   * Brand and Model
  Serial No
  Battery Type And Number
  Date Purchased
  Address
     
   * Depending on the electronic equipment and number
   * Observed problems
  Alarms
     
  Security Code
   
     
     
 
 
 
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