Contact Name:**

Contact Phone Number:**

Fax Number:
 
Company Name and Address**

Email Address:**
 
Case Number, if you have been assigned one:

Drive Type: Bulletin Number or Catalog Number I.E. 1388B-AV40:**

Drive Serial Number or Sales Order Number:

Problem Description**

Fault Codes:

Incoming line voltages and currents:

Have incoming line impedance equipment (chokes or transformers) been installed? What size?
 

Description of Application.
 

Information on other control devices, i.e. PLC's or IMC's.
 

Environmental conditions of the installation.
 

How long has drive been in operation?
 

Firmware level if applicable:
 

Any other information you wish to input: