Please select one of the following alternatives :

Additional request :

Fields marked with * must be filled in

*Name:

*Company:

*Shipment Address:

*Town/City:

*Zip/Post Code:

State (USA Only):

*Country:

*Telephone:

*Email:

*No of Returning Devices: (Indicate TOTAL return quantity)

*No of Returning Devices that have been installed in the field

*Returning Anybus Product Type/s:

HMS Part No/s:

*Product Serial Number/s:

*If the problem is functional: Please try and include the following:

 How was the fault confirmed?
 How does the fault appear?
 Under which circumstances does the  fault appear?
 How is the environment around the installation?
 How was the faulty product isolated?

*If the problem is visible: Please try and include the following:

 Postion, which component, affect of the visible malfunction