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Problem Report Form C-1

Appendix C KODAK Professional

DCS 465 Digital Camera Back

Problem Report Form

Customer Return Address

Name _______________________________________________________________
Company____________________________________________________________
Address _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
City________________________________ State ____ Zip _________ ______
Phone ( ) ______________________________________________________

Equipment Description

DCS 465 Camera Serial Number ______________________
(See the data label on the top of the DCS 465 Camera Back.)

Problem Description

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________