SHIP ORDERS TO:

3E Services, Inc. 5002 N. Royal Atlanta Drive S$ite % +$c,er, -A 300"* www.iemro.com Phone: 0! 23!0"# &a': 0!(3#!)(*" email: c.smith.3eservicesinc.com /harles Smith

Packing Slip
Your Company Name__________________________ Contact Person _______________________________ Return Shipping ______________________________ City, State, ip ______________________________ !o" did you hear about us# ______________ Purchase Order _____________________ Customer Ref#______________________ Job Urgency _______________________ Your Phone_________________________ Your $a% __________________________

Your Email Address& ________________________________________________________________ IMPORTANT NOTE: CREDIT CARD PAYMENT MAY E RE!"IRED #OR NE$ C"STOMERS% 'uantity (anufacturer (ode)*Part Number Repair Urgency

"rgen& repair ser'ice re(ues&s carr) addi&ional c*arges+ Standard Repair Ser,ice& - to ./ 0usiness 1ays+ 2S2P Ser,ices& - 0usiness 1ays 3 .-4 up5charge 6min 7.889+ RUS! Repair& : 0usiness 1ays 3 :-4 up5 charge 6min 7:889+ Specia) Return Shipping ;nstructions 6all items will be shipped UPS Ground, Insured for twice the repair price unless specified otherwise by the customer9& No&e: Please enclose documen&a&ion +i%e% prin&s, manuals, e&c- and a de&ailed descrip&ion o. &*e speci.ic pro/lem 0i&* eac* uni&% T*e more in.orma&ion )ou can pro'ide us &*e (uicker, more relia/le, and leas& e1pensi'e repair 0e can o..er+

Customer $ai)ure 'uestionnaire

<e appreciate you ta=ing the time to pro,ide the information be)o" "hich "i)) great)y enhance our abi)ity to pro,ide you "ith the highest >ua)ity and most re)iab)e repair "or=+ Use re,erse side if needed+ P)ease e%cuse any >uestions that might seem ob,ious to you+ ?his is a form designed to capture as much information as possib)e to best he)p you get the e>uipment bac= up and running 2S2P+ ;mportant& P)ease inc)ude any and a)) contro)s possib)e 6i+e+ dri,e =eypads, etc9
.+ Have you verified the item being sent is the defective part (i.e. burnt parts, or replaced with identical parts to get back up and running, onsite technical confirmation, etc.)? :+ Do you know if the part failure was due to an external issue that could cause a repaired part to also fail (i.e. defective external part, power surge, water or chemical damage, or machine damage, etc.)? f so, please explain. !se reverse side if necessary.

@+ "hat was the first sign there was a problem occurring in the e#uipment (what was happening)? /+ "as there a specific fault shown on monitoring indicators (i.e. $% &ault, $' &ault, etc)? -+ "hat do you think caused the failure (i.e. burned part, fault indication, etc.)? A+ f there was no specific fault indicated by the e#uipment directing you to suspect this unit, why do you think it is defective (i.e. did you confirm it is defective by replacing with a good unit)?

B+ Do you have technical info such as schematics, block diagrams, manual or connection drawings that can be sent with the item, or provided by fax or email? (lease provide any current, voltage or $)*cope readings that we should see from various output points on a good unit if known. C+ &or items that cannot be operationally tested due to availability of proprietary support e#uipment would you be able to provide this e#uipment (i.e. servo) motor to test a speciali+ed servo drive, a duplicate good unit to perform $)*cope comparisons, etc +)?

D+ %an you provide a technical contact (name, phone, , email) that the technician that is working on your unit can contact direct for fault discussion?