W.H. BRADY CO.
Customer Service Form
This form should be completed in full before requesting
techncial assistance.
Complete this form before requesting technical assistance.
Serial # ______________________________________________________________
Model # __________________________________________________________
(Be specific: include ALL letters and numbers)
Company _____________________________________________________________
Address __________________________________________________________
City _____________________________________________________________
State, Zip _________________________________________________________
Phone # (_______) _________________________________________________
Contact __________________________________________________________
Hours available for return call ____________________________________________
Hardware interface type _________________________________________________
Unit interfaced with ____________________________________________________
Description of problem, including actions taken just prior to problem occurring:
_________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
E-3
