Siemens SED2 VFD Start-Up page 11

This form is to be used by authorized personnel to verify proper application and installation of SED2
standard drive components. This form must be filled in completely and returned to the Siemens
Industry, Inc. address on this form within 10 working days of start-up to properly validate the
warranty. Validation is determined by Siemens Industry, Inc. Unit serial number MUST be
included below to validate certification.
A. Customer Information:
Purchased From:
Contact:
Address:
City:
End User:
Address:
City:
B. SED2 Information:
Unit P/N:
C. Motor Information:
Manufacturer:
D. Application:
Application (fan, pump, etc.):
E. Installation Information:
I certify that start-up of the SED2 VFD has been accomplished according to instructions and procedures contained in the
SED2 Start-up Procedure and Checklist, Installation and Start-up Guide, and Operation and Maintenance Manual.
Installation and/or start-up of the SED2 VFD does not conform to the above for the following reason(s):
F. Start-up Performed by:
Start-up Performed by (Please print):
Signature:
Company:
Customer Name (Please print):
Customer Signature:
Form 994-942P25
Revision Date September 24, 2010
Certified Start-up Form
State:
State:
Unit S/N:
Model:
(check one)
Siemens Industry, Inc.
Building Technologies Division
1000 Deerfield Parkway
Buffalo Grove, IL 60089
Attn: National Repair Center
Date of Start-up:
Email:
Phone:
Contact:
Email:
Phone:
Software Version:
HP:
ID Registration Number:
Date:
Phone:
Date:
Copy Distribution: Home Office – Customer – Technician
Complete and return to:
Fax to: 847-941-3819
RPM:
Customer
Notified