Factory Service Information Form - Crown IQ-PIP-USP3 Reference Manual

Programmable input processor with tcp/iq

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Crown Factory Service Information

Shipping Address: Crown Factory Service,

1718 W. Mishawaka Rd., Elkhart, IN U.S.A. 46517

Phone: 1-800-342-6939 or 1-574-294-8200 Fax: 1-574-294-8124

Owner's Name: __________________________________________________________

Shipping Address: _______________________________________________________

Phone Number: __________ Fax Number: ___________ Email: __________________

Model:________________________________

Serial Number: __________________

Purchase Date: ________________________

RA Number: __________________

NATURE OF PROBLEM

(Be sure to describe the conditions that existed when the

problem occurred and what attempts were made to correct it.)

_____________________________________________________

Other equipment in your system:

_____________________________________________________

If warranty has expired, payment will be:

❏ Cash/Check

❏ VISA

❏ MasterCard

❏ C.O.D. ❏ P.O. for Crown Dealer

Card Number:___________________________

Exp. Date:___________

Signature:____________________________

ENCLOSE THIS PORTION WITH THE UNIT.

DO NOT MAIL SEPARATELY.

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