BIPLANAR^® INSTALLATION REPORT

Before shipment the Installation Report below has to be completed and submitted.
Please use separate forms for each system.

End customer (Hospital, Institute) *

Department *

Address *

Postal code *

City *

Country

Telephone

Contact person

Product model *

Serial number (see order confirmation) *

Distributor name *

Your purchase order ID *

Installation by *

Installer name *

Telephone *

E-mail *

Attended technical training? *

Technical training date (YYYY/MM/DD) *

Planned installation date (YYYY/MM/DD) *

Further information

BIPLANAR® INSTALLATION REPORT