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Contact Name:
______________________________________________________________
Company Name:
______________________________________________________________
Street Address:
______________________________________________________________
City: __________________________
Province/State:
_________________________
Country: __________________________
Postal/Zip
Code:
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Phone Number:
__________________________ Extension:
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Failure or Problem Description
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(if not under warranty)
Fax this form to Kontron’s Technical Support department
in North America at (450) 437-0304
in EMEA at +49 (0) 8341 803 339
