Defective Hot Swap Report Dealer Information* or required Indicate Required FieldsYou must enter detailed information in the required fields.Dealer* Submitter's Name* Submitter's Phone*Submitter's Email* Return Name & Address*Where do you want the detector sent after repair? System InformationUser's Name HiddenUser's PhoneHiddenUser's Email Hospital/Clinic Name* HiddenCountry/City Install Date MM slash DD slash YYYY System Type* System S/N* System S/W System Status*Not DownPartial DownHard DownCoverage Type*WaranteeBillableContractDemoUltraSound Model* UltraSound Part Number* UltraSound Serial Number* Detector F/W Defect Category* Physical Damage Connection Issue Image Quality Frequency of issue* Constant Intermittent Conditions* Wired (tethered) Wireless Hot Swap*Are you requesting a Hot Swap? Yes No Hot Swap Ship-To Address*If you are requesting a Hot Swap, enter ship-to address. If you are not requesting a Hot Swap, put N/A. Details*HiddenDetector Front PhotoPlease attach detector front photo:Max. file size: 50 MB.HiddenFront Photo Remarks Photo Information Detector Back PhotoPlease attach photo of detector s/n from behind batteryMax. file size: 50 MB.Back Photo RemarksHidden#1 [Left Up]Attach shock sensor photoMax. file size: 50 MB.Hidden#1 sensor normal break Hidden#2 [Right Up]Attach shock sensor photoMax. file size: 50 MB.Hidden#2 sensor normal break Hidden#3 [Right Down]Attach shock sensor photoMax. file size: 50 MB.Hidden#3 sensor normal break Hidden#4 [Left Down]Attach shock sensor photoMax. file size: 50 MB.Hidden#4 sensor normal break HiddenEngineer's Comments Signature HiddenMain ConnectorAttach Main Connector Photo:Max. file size: 50 MB.HiddenMain Connector RemarksHiddenBattery ConnectorAttach Battery Connector Photo:Max. file size: 50 MB.HiddenBattery Connector RemarksEngineer's Signature* Date signed* MM slash DD slash YYYY Form NotificationPlease send confirmation to [email protected] to submit this form. Email Confirmation* Enter Email Confirm Email Email Confirmation 2 Enter Email Confirm Email Email Confirmation 3 Enter Email Confirm Email HiddenUnique ID Δ