Customer Complaint Form

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( * = Required Information)

*Customer:

*Contact:

*Phone Number:

*E-mail:

*Cust Part Number:

Rev:

Falco Part Number:

Your Ref Number:

Description of Problem:

Requested Disposition of Parts:

Magnitude of Failure

Sample Size:

pcs

Date Code:

Percentaje Fall Out:

Falco Box Serial Num.

Are you sending sample of defectived parts to Falco? Yes

Carrier:

Tracking Number:

Note: Send samples directly to the headquarters in México:
Falco Electronics Mexico SA de CV.
Calle 23, #311,
Fracc. Itzincab,
Mérida, Yucatán,
México 97392
Phone: +52 (999) 930-0270
Attn: Tony Vallado

Additional Information (Required)
This information will be used to send you a copy of the data submitted and to have a better traceability.

*Entered by:

*E-mail:

Attachments
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mccl.asp, 4/13/2000, Rev: B1


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