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PRODUCT QUALITY ACTION REQUEST
Please fill out as complete as possible. * Are required fields

 
*Company/Distributor: 
Date Reported:
*Contact Name: 
*Telephone Number:
Street Address:
 *E-Mail Address:
City:
 State/Province: 
Postal Code:
Country:
Purchased From/By:

 *Date Purchased:
*Model Number:
#1		 *Qty:
*Serial Number (s) *Date Code
*Model Number:
#2 		*Qty:
*Serial Number (s) *Date Code
 
*Model Number:
#3 		*Qty:
*Serial Number (s) *Date Code
 
*Use and Location (Type of Music, Venue):
*Product Problem (include a drawing or photo):
*Circumstance When Unit Failed:
Disposition
Internal Test Performed:

Results:

 
FOR JBL USE ONLY:
 Reference #
JBL Contact Name: 

Department:
Car#: 

Return Authorization#:
Closure Approval: 

Closure Date:
Customer Informed By:
Customer Informed Via:



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11/8/01