Dealer Code
Date
Dealer Firm Name
Dealer Email ID
Doctor’s Name
Sr. No. of X-Ray Unit
Unit Condition
Working
Physical Condition
GoodNot Good
Accessories with unit
Neck StrapAdapterCradle(Base)PackingBox
Sr. No. (New Installed EzRay Air Unit)
Installation Report ID from SMS App
Terms & Conditions Document (Signed)
YesNo
Invoice No.
To Customer
To Vatech
Attach Documents Sent to Vatech (From Doctor Email) YesNo
Yes I agree