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Problem Report Form H-1
Appendix H — Problem Report FormKODAK Professional RFS 3570 FilmScanner

Customer Return Address

Name_______________________________________________________________
Company____________________________________________________________
Address _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
City________________________________ State ____ Zip _________ — ______
Phone ( ) ______________________________________________________
Date ________________________________________________________________

Equipment Description

Scanner Serial Number — ______________________
(See back of Scanner under “Serial Number.”)
Return Authorization Number ______________________
Provided by the Kodak. Refer to “Appendix G— Repacking Instructions” for additional
information.

Problem Description

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________