Hitachi Vortex Blowers Warranty Registration Form

Please complete the form below for Hitachi Vortex Blowers Warranty Registration. The fields indicated with an asterisk (*) are required.

Note:

1. This document must be completed by an authorized Hitachi Distributor or End Customer
2. By clicking submit, you will be sending this form to atgwarranty@hal.hitachi.com
3. This document is the initial registration of the unit for warranty
4. You have only 30 days after invoice to submit this document to Hitachi to register the Blower for warranty effects

Personal Information

Qualified Technician (performed the installation) *	First name: Last name:
Date *	Month: Select January February March April May June July August September October November December Day: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: Select 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Purchase Date *	Month: Select January February March April May June July August September October November December Day: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: Select 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Model # *	Select E/E2-SERIES; High Volume Type Single Phase, Dual Input Voltage -- VB-001SE-U -- VB-002SE-U -- VB-003SE-U -- VB-004SE-U -- VB-007SE-U E/E2-SERIES three PHASE) -- VB-004E-U -- VB-007E-U -- VB-019E-U -- VB-030E-U -- VB-040-E2 -- VB-060-E2 -- VB-080-E2 -- VB-110-E2 G-SERIES, HIGH PRESSURE TYPE G-SERIES single PHASE) -- VB-001SG-U -- VB-002SG-U -- VB-003SG-U -- VB-004SG-U -- VB-007SG-U G-SERIES three PHASE) -- VB-001G-U -- VB-002G-U -- VB-003G-U -- VB-004G-U -- VB-007G-U -- VB-015G-U -- VB-022G-U
Hitachi Distributor
Distributor Location
Company name: *
Type of Industry *
Start Up Date *
Invoice # *
Manufacturing # *
Customer Address  *
Customer City  *
Customer State  *
Customer Zip Code  *
Customer Phone No.  *
Customer Email Address *

Installation Conditions

Unit installed indoors? *	Yes No
Chemical or high dust area? *	Yes No
Unit used for suction (vacuum)? *	Yes No
Unit used for discharge (pressure)? *	Yes No
Inlet filtration for the unit? *	Yes No
Power cable capacity Amps and Voltage, checked? *	Yes No
Did you receive the instruction Manual of the VB? *	Yes No
Did you read and follow the installation guidelines on the instruction manual of the VB? *	Yes No
Supply Voltage *	Volts: Select 110 208 230 460 Other Phases: Select 1 3
Was the blower commission satisfactory? *	Yes No
Comments
Started up by  *
Customer responsible  *
Title  *