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EQUIPMENT INCIDENT REPORT
Please enter as much information as you can. Send the completed form, together with the item for repair to your nearest authorized service
agent. NOTE: Only one fault to be recorded per form.
For further information contact the Powerware DC Product Services Division
Telephone:++64 3 343 3314 or Fax: ++64 3 343 7446.
Date: ...........................
Customer Information
Company: .....................................................................................................................................
Postal Address: ....................................................................................................................................
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Return Address (Not PO Box): .............................................................................................................
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Telephone: ................................. Facsimile: ........................... E-mail: ............................
Contact Name: ...................................................................................................................................
Location of Failure
Product code........................ Serial number............................. Document No...................................
System type installed in............................................................... Serial number...................................
Site name or location...............................................................................................................................
Fault discovered Delivery Unpacking Installation
Initial test Operation after..........years ......................
Failure source Design Manufacturing Documentation
Transportation Installation Handling
.............................
Effect on system operation None Minor Major ................................
INFORMATION (fault details, circumstances, consequences, actions)
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Internal use only.
Reference No:............ RMA: ............. NCR: .............. Signature: ........................ Date: .................