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Ship to: Imagin Systems Corporation
517 Marine View Ave. #H
Belmont, CA 94002
RMA# & Date
Imagin Use only
CUSTOMER NUMBER
Dental Office
Doctor's Name
Last Name
Contact
Street Address
City
State
Postal/Zip code
Office Phone
Fax
Cell
Country
Country
arrow&v
Email
ITEM DESCRIPTION FOR REPAIR: SHIPPING INSTRUCTIONS:
X-RAY SENSOR
I/O CAMERA
IOS 3D CAMERA
OTHER
Brand
PLEASE SELECT A RETURN SHIPPING SPEED,
UPS
GROUND
IS STANDARD IF LEFT BLANK
1-DAY
2-DAY
3-DAY
Model
Serial Number's
Shipping Insurance
Tell us what is happening to the best of your ability, Please don't Just say "Not Working"
Imaging Software used (i.e. Eaglesoft, Dexis, VixWin, Apteryx) List accessories ingluded:
USB CABLE
ATTACHMENTS
SOFTWARE-DISC/THMB DRV.
PC
MAC
TO FINISH:
STEP 1
:
PRINT THIS FORM
BY TYPING...
CTRL - P
And Make Sure You Put a Copy of this Form in Your Shipping Box!
STEP 2:
PRESS THE SUBMIT BUTTON BELOW
TO
SUBMIT THIS FORM
Please Read the Following Conditions Carefully:
• Please take care when packaging your items to prevent damage in transit.
•
All repairs
will be given a
90-day limited warranty
for parts and labor
unless otherwise stated on the quotation
provided.
Equipment left over 90 days will be scrapped & we aren’t responsible for them after that point.
•
If an Item is unrepairable a $50 return shipping/handling fee
will need to be made to receive items back.
• Please include the amount of insurance you want on return shipping; we are not responsible for lost items.
By Submitting this Form, You Understand the Conditions Above
SUBMIT THIS FORM
Thanks for submitting!
Clicking on these shipping Icons, only
he
lps direct you to these shipping sites.
(
you must organize your own shipment due to liability)
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