Form 994-942P25 Copy Distribution: Home Office – Customer – Technician
Revision Date September 24, 2010
Certified Start-up Form
This form is to be used by authorized personnel to verify proper application and installation of SED2
standard drive components. This form must be filled in completely and returned to the Siemens
Industry, Inc. address on this form within 10 working days of start-up to properly validate the
warranty. Validation is determined by Siemens Industry, Inc. Unit serial number MUST be
included below to validate certification.
Complete and return to:
Siemens Industry, Inc.
Building Technologies Division
1000 Deerfield Parkway
Buffalo Grove, IL 60089
Attn: National Repair Center
Fax to: 847-941-3819
A. Customer Information:
Purchased From:
Contact:
Date of Start-up:
Address:
Email:
City:
State: Phone:
End User:
Contact:
Address:
Email:
City:
State: Phone:
B. SED2 Information:
Unit P/N:
Unit S/N: Software Version:
C. Motor Information:
Manufacturer:
Model: HP: RPM:
D. Application:
Application (fan, pump, etc.):
E. Installation Information: (check one)
I certify that start-up of the SED2 VFD has been accomplished according to instructions and procedures contained in the
SED2 Start-up Procedure and Checklist, Installation and Start-up Guide, and Operation and Maintenance Manual.
Installation and/or start-up of the SED2 VFD does not conform to the above for the following reason(s):
Customer
Notified
F. Start-up Performed by:
Start-up Performed by (Please print):
ID Registration Number:
Signature:
Date:
Company:
Phone:
Customer Name (Please print):
Customer Signature:
Date:
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