BATTERY ISSUE NOTIFICATION

The undersigned confirms receipt of the ZOLL AED Plus battery issue notification. We would like to exercise the following solution for the indicated ZOLL AED PLUS.

If you would prefer to fill out this form by hand and fax it to us, please click here to download a pdf copy.

E-mail Address: * Serial # Options: Software upgrade Change batteries every 3 years Serial # Options: Software upgrade Change batteries every 3 years Serial # Options: Software upgrade Change batteries every 3 years Serial # Options: Software upgrade Change batteries every 3 years Serial # Options: Software upgrade Change batteries every 3 years Serial # Options: Software upgrade Change batteries every 3 years Serial # Options: Software upgrade Change batteries every 3 years Owner or Company/Agency Name Contact Name Address Phone Fax Date Signed (please write your name here to sign this form) Position * Required

If you need to report more than 10 serial numbers, please submit this form and then fill it out again to submit additional serial numbers.

2009 HeartZAP Services Inc.