Warranty Claim Form

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	If you are reading this it is because we are administering a warranty repair claim on your original EIZO Monitor/graphics card. Please accept our apologies for any inconvenience you are experiencing as a result of this equipment failure. Your co-operation in completing and returning this simple form will enable us to start on the solution right away. EIZO OCEANIA SUPPORT TEAM can be contacted on Tel: +61 2 9462 7500. Usage Time information can be found in the screen manager menu under "information" (3rd screen).

	Fields marked with the asterisk * are mandatory. To send the claim service request please click on Send.
Your Details
	*Company Name
	*Contact Person
	Reseller (if any)
	*Contact Phone Number
	*Email Address
	*Delivery Address1
	Delivery Address2
	*State/Territory
	*Postcode
	Country	Australia New Zealand

Please specify claim details below.
	*Model name
	*Serial Number
	*Invoice Number
	*Purchase Date	(DD/MM/YYYY)
	*Usage Time
	Defect Occurred Date	(DD/MM/YYYY)
	Frequency of Fault	Always Sometimes Begin use When time passes At specific operation
	Nature of Defect
	Environment	(mandantory for Graphics card)
	Computer:
	OS:
	Board driver:
	Monitor:
	Resolution:

Please check the information you enter before clicking Send.