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Completion of this form is optional.

However, by providing the information requested below you will assist us in the diagnosis and repair of your servo device. As a result, we will be able to provide you with a more efficient repair service resulting in a faster turnaround time for you or your customer. Please designate whether you are interested in AC servomotor, DC servomotor, spindle, spindle motor, tachometer, resolver, or encoder repair.

Contact Information

Company Name *

Contact Name *

Email Address *

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Extension

PO #:

RMA #:

Servo Device Information

Type of Device

Manufacturer

Model Number

Serial Number

This device is used on the following machine

Type of Machine

Manufacturer

Model Number

Serial Number

Evaluation Questions

Please Check one of the following:

When the servo failed, I noticed the device: (check all that apply)

I confirmed this device was bad by: (check all that apply)

I have checked: (check all that apply)

If the failure was intermittent, please answer the following questions:

1. How often does the failure occur?

2. In the list below, check all of the symptoms that are associated with the intermittent failure:

Comments / Describe the Failure:

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