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Complaint
Please fill out the form below so that we can process your complaint as soon as possible.
Customer Complaints
Complaint form
recorded by
Company
Date
Customer
Company
*
Customer number
Address
Title
Please select
Mr
Ms
Name
*
Firstname
Contact data
*
Phone
*
claim reference
Claim
manufacturer
CHOOSE MANUFACTURER
OKIN
Dewert
OKIN Refined / Mechanics
DOT
invoice no.
ID-no. of article
function in application
PLEASE SELECT
Power supply
Control unit
cabel
back rest
foot rest
double actuator
Lift actuator
Handset
supervisor box
Production / order no.
order confirmation
quantitiy claimed
quantity delivered
quantity returned
select place of non conformity
select place of non conformity
at customer in receipt/production/test
at final customer during use
Please give detailled information describing what is non conforming; Give information for non conformity and components in cooperation.
Detailed description of claim
customer
PLEASE SELECT
sends this just for information
requests finding of defect (product necessary to be send)
requests root cause analysis (set necessary to be send)
needs a report in
NONE
german
english
Component 1
Component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serail-no.
Add More Fields
Component 2
Component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serial-no.
Add More Fields
Component 3
Component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serial-no.
Add More Fields
Component 4
component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serial-no.
Add More Fields
Component 5
Component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serial-no.
Add More Fields
Component 6
component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serial-no.
Add More Fields
Component 7
component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serial-no.
Add More Fields
Component 8
component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serail-no.
Add More Fields
Component 9
component
PLEASE SELECT
Power supply
Control unit
Cable
back rest actuator
foot rest actuator
double actuator
Lift actuator
Handset
Supervisor box
ID-no. of article
quantity
Serial-no.
Complaint form
picture / label
Critical errors (A)
Error that affects security.
Main error (B)
Functionality of the component severely limited; failure of functions necessary for operation
Secondary error (C)
Have no significant consequences or negligible impairment.
Weighting by PM Sales Division:
NONE
A
B
C
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