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Equipment Details

S.No. Urgency Qty(s) Model/Part No. Serial No (Optional) Manufacturer Part Description Est. Price Description of Problem


I Confirmed the Device/Unit was bad by:

Replacing and Installing a good unit resolved the problem

Installing the device on a good motor/drive/machine (problem followed the Unit)
I was unable to confirm the Unit was defective by swapping

Additional Description of Failure(Alarm Codes, blowing fuses, strange sounds etc.)

Your Billing Address

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Your Shippping Address

 Please check this box if Shipping Info same as Billing Info
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Customer P.O. # (Optional)




Click This button to `Print Packing Slip` When Done


Click This Button to `Submit` Repair Form if using Own `Packing Slip`