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Vending Machine Failure Report

Please fulfill the following questionnaire for Technical Support, we will contact you shortly:

Name:  
Company:  
Title:  
Address:  
City:  
Phone number (Office):  
e-mail:  
Kind of vending Machine:  
Detected Failure:  
Comments:  
   
Note: All data required in this questionnaire is necessary, your information will be confidential

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