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["修理依頼書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,20,null,"年",null,"月",null,"日"]
["●当社に修理を依頼するに当たり、該当欄の内容入力をお願いたします。"]
["●入力した依頼書はA4用紙に印刷し、修理依頼品に同梱してください。"]
["●修理依頼品は、下記の当社カスタマーサービスセンターまで送付してください。"]
["●依頼品を当社に送付する際の送料はご依頼者様元払いとさせていただいております。"]
["●「見積不要」の場合は直ちに修理を開始致します。"]
["●医療機器業公正規約により、代替機貸出は原則有料とさせていただきます。"]
["御社名",null,null,null,null,null,null,null,null,null,"営業所",null,null,null,null,null,null,null,"ご担当者様"]
[]
[]
["TEL",null,null,null,null,null,null,null,null,null,null,null,null,"FAX"]
["携帯電話",null,null,null,null,null,null,null,null,null,null,null,null,"MAIL"]
["使用施設/ユーザー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ユーザー所在地"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（市町村)"]
["修理品",null,null,null,null,null,null,null,null,null,null,null,null,"付属品"]
[]
[]
["修理履歴"]
[]
["故障発生頻度"]
[]
["購入日",null,null,null,null,null,"年",null,null,"月",null,null,"日","シリアル番号"]
[]
["代替機レンタル"]
[]
[null,null,null,null,"レンタル期間が3ヶ月を超えた場合、追加料金が発生します（無償レンタル品も含む）"]
["有償レンタル料金",null,null,null,null,null,null,null,null,null,null,null,null,"修理見積"]
[]
["故障内容（詳細）"]
[]
[]
[]
[]
[]
[]
[]
["株式会社ナイツ\n カスタマーサービスセンター",null,null,null,null,null,null,null,null,null,null,null,null,"〒389-0601",null,null,null,"長野県埴科郡坂城町坂城6249"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL","0268-82-8377",null,null,null,null,"FAX","0268-82-8378"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"https://www.neitz.co.jp/"]