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Contact Name:
______________________________________________________________
Company Name:
______________________________________________________________
Street Address:
______________________________________________________________
City:
__________________________ Province/State:
Country:
__________________________ Postal/Zip Code:
Phone Number:
__________________________ Extension:
Fax Number:
__________________________ E-Mail:
Serial Number
Kontron Canada, Inc., 616 Curé Boivin, Boisbriand, Québec, Canada, J7G 2A7
Fax this form to Kontron's Technical Support department in Canada at (450) 437-0304
Authorization Request
Failure or Problem Description
F-3
Return to
Manufacturer
_________________________
_________________________
_________________________
_________________________
(if not under warranty)
AT8001 User's Guide
P.O. #
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