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Contact Name:
__________________________________________________________
Company
__________________________________________________________
Name:
__________________________________________________________
Street
Address:
City:
________________________
Country:
________________________
Phone
________________________
Number:
Fax Number:
________________________
Serial Number
Failure or Problem Description
Fax this form to Kontron's Technical Support department
in North America at (450) 437-0304 or
in EMEA at +49 (0)8341 803 339
Return to
Manufacturer
Authorization Request
Province/State:
_______________________
Postal/Zip Code: _______________________
Extension:
_______________________
E-Mail:
_______________________
P.O. #
(if not under warranty)
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