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1672 Wright Blvd. Schaumburg, IL 60193 Phone: 847- 891- 6210 Fax: 847- 891- 6215 Email: admin@accessmedicalsupply.com www.accessmedicalsupply.com □ Call Tag Defective Product or Equipment Incident Report Date: Sales Associate: Account: Manufacturer: Address: Product Number: City State Contact Person/Phone: Zip Lot Number/Serial Number: Quantity: Nature of Complaint: Information taken by: Date: Correction Action Taken: Action Taken By: Date: ...
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