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RMA

Ink report questionnaire


Rev. 1.2 (03-12-2019)

 Date: 04/01/20
 Company name: ACTICO
 Contact name: Ahmad Alayesh
 Invoice number: 303161
 Name of affected ink: K3010 - HSAJET K3010 Premium Black dye Ink cartridge
 Number of cartridges affected: 100
 Lot number(s): _202903_____
 Fill date(s): __09 sep 2019____
 Cartridge Serial No: (T10 GAXXXX): ______
 Name of printer used
 Firing parameters used:
o Voltage: ______ [V]
o Fire pulse: ______ [µs]
o Pulse warming: ______
 Substrate (material printed on): ______
 Ambient Temperature (room temperature during production): ___25__ [°C]
 Humidity during production (if possible): __N/A___ [%]
 Print frequency: __12000____ [prints/hour]
 Print speed: ___5.5___ [m/min]
 Resolution: ___300*300___ [DPI]

 Horizontal or vertical printing (print on top or on site of product, or other): _print on side _____

 Picture of failure should be attached: Name(s) of file(s): ________

 Detailed description of failure:


________________________
_____________________________________
____________________________________

 Has the same failure occurred before for the same type of ink?
o YES
o NO
If Yes, please describe in few words:
________________________
________________________

NB. Please keep the cartridges until further notice.

HSA Systems Sarl HSA Systems


19 Rue de L'Universite | F-93160 Noisy-Le-Grand | France Mileparken 16 | DK-2740 Skovlunde | Denmark | +45 4494 0222
HSA Systems GmbH Egegaardsvej 3 | DK-5260 Odense S | Denmark | +45 6610 3401
Schierbusch 2a | D-33161 Hövelhof | Germany www.hsasystems.com
RMA
Ink report questionnaire
Rev. 1.2 (03-12-2019)

FOR HSA
Date received:
Received by:
Additional information received (email etc.)? 
If the case, filed along with sheet 
Remarks:

Case closed 
Date:
Init:

HSA Systems Sarl HSA Systems


19 Rue de L'Universite | F-93160 Noisy-Le-Grand | France Mileparken 16 | DK-2740 Skovlunde | Denmark | +45 4494 0222
HSA Systems GmbH Egegaardsvej 3 | DK-5260 Odense S | Denmark | +45 6610 3401
Schierbusch 2a | D-33161 Hövelhof | Germany www.hsasystems.com

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