Warranty Service Request
1319 Lincoln Avenue
Waukesha, WI 53186
www.cooperpower.com
This form will provide the warranty services team with the information necessary to
provide you with the best possible service.
Please be as complete as possible with all information.
Date:
Contact Name:
Title:
Business Type:
Company:
E-mail:
Phone:
Fax:
Address:
Address 2:
City:
State:
Zip/Postal Code:
US
Country:
Return Ship To Location:
Contact Name:
Phone:
Address:
Address 2:
City:
State:
Zip/Postal Code:
Country:
Original CPS Sales Order or PO#:
Products Involved (select all that apply):
Arrester Product
Cable Accessory Product
Connector
Fault Indicator
Fuse Product
1 Phase Switch
Hi-Line Equipment & Tools
SecTER / Ground Sleeves
3 Phase Switch
1 Phase Overhead Transformer
1 Phase Pad-mount Transformer
3 Phase Pad-mount Transformer
Substation Transformer
Voltage Regulator / Control
Capacitor Product
Pad-mounted Switchgear
Form 6 Recloser Control
F4 / F5 / Other Recloser Control
1 Phase Overhead Switchgear (Recloser)
Quantity Affected:
Catalog #:
Relay
Cut-out
Other - Not Listed Product
Serial #:
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Has the product been installed or energized?
Yes
No
Date of Install or Energization:
Date issue was discovered:
Your Reference Number for the issue:
Description of the issue. Please provide detailed information.
Note: for new or returned Form 6 controls, ProView version 4.0.1 will be supplied unless otherwise specified by customer.
Upon service ticket completion - reply requested:
No thank you, none is needed
Service e-mail of what was found
Formal report with corrective actions
Have you previously notified Cooper Power Systems of the issue on this product?
No, this is the first request
Yes, I previously notified Cooper Power Systems
Date Notified:
If known, please enter the following sales agent information so that they receive a copy of this request.
Agent/Rep/Sale Engineer:
E-mail:
Inside Sales Rep:
E-mail:
Submit by E-mail
Print Form
PLEASE ATTACH ANY REFERENCE DOCUMENTS TO THE E-MAIL MESSAGE.
FAX PRINTED FORMS TO: (770) 268-7002
MC0901 • March 2009 • New Issue
©2009 Cooper US, Inc. All Rights Reserved.
All Cooper logos and Cooper Power Systems are trademarks of Cooper US, Inc., in the U.S. and other countries. You are not permitted to use Cooper trademarks without the prior written consent of Cooper US, Inc.
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