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Type of Media: |
Reflective Layer: |
Size: |
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Description of the problem:
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Error messages reported by the equipment:
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Serial (lot) number from the center of
failed disc: |
MAM-A
Part number (Item number): |
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12-14
digits |
8 digits |
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Box ID number:
(located in the upper right corner of the front of the shipping
carton) |
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6 digits |
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Brand name of burner: |
Model number: |
Firmware |
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Burn Speed: |
Computer
Operating System: |
Software: (e.g. Nero, Roxio,
Toast): |
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Date Purchased: |
Where
Purchased: |
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Quantity purchased: |
Quantity defective |
Sales Person: |
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Company Name: |
Position: |
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| Customer First Name: |
Last Name: |
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| Shipping Address: |
City: |
State |
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| Zip/Postal Code: |
Country |
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5 digits |
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| Telephone Number: |
Fax: |
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Customer Email:
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