Form: SG6014-00 0496 Siemens Energy & Automation, Inc.
Protective Relays Service Request Form
Siemens Energy
& Automation, Inc.
Protective Relay Group
Customer Service
P.O. Box 29503
Raleigh, NC 27626-0503
To report problems with Siemens protective relays, make a copy of this form, complete it with as much infor-
mation as you can, and fax it to Siemens Customer Service at 919-365-2583. Call customer service during
regular business hours at 919-365-2395. For emergency service call 1-800-241-4453.
Customer Information
Company name:
Contact person at job site:
Contact persons phone number:
Contact persons fax number:
Location of installed device:
Product Information
Device type:
Serial Number:
Catalog number:
Sales Order Number:
Configuration Information
Operational settings:
Parameters:
Wiring:
Type of system:
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