Siemon Warranty Registration/Change Application

Warranty Registration and Change Application
We recommend using Google Chrome to complete this form

Please be sure to have the following information available prior to starting entry into the form:
- Your company information
- Authorized Designer/Installer Certification Number
- End User information
- Installation Site information
- Project information and requested Siemon Warranty type
- Number and types of test results. All must be consolidated into a single .zip or tester file prior to upload
- Siemon product and cable used on this project
- If applicable, the previously exception ID# from the Exception Approval email
- Please do not use any of the following characters in the test file names that you are uploading: ! # $ & ' ( ) * + , / : ; = ? @ [ ]. If your file name contains any of these characters, save it with a new same before uploading.

Warranty Registration and Change Application
Region
Warranty Registration Application
Warranty Change Application
Type *
Please select New Warranty Registration or Warranty Change Application
Is there an approved Exception related to this request? *

Yes No
Please enter the Warranty Exception ID from the approval email *
See example above for correct format
Original Registration Number *
This field is required for all Warranty changes.
Authorized Designer/Installer Information
Name *

First Name Last Name
Certification Number *
Company *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
E-mail *
Fax Number

- Area Code Phone Number
End User Information
End User Contact *

First Name Last Name
End User Phone Number *

- Area Code Phone Number
End User E-mail *
End User Company *

End User Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Installation Site
Is the Installation Site location the same as the End User location?

Yes
Installation Site Contact Name

First Name Last Name
Installation Site Company
Installation Site Contact Phone

- Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

About the Project
Project Name to appear on the Certificate of Registration *
Project Start Date *

- Month - Day Year
Date
Project Completion Date *

- Month - Day Year
Date
Was the project subcontracted? *
If Yes, from which Siemon Certified Installer company? *
Type of Siemon Warranty *
Hold CTRL to select multiple Warranty Types
Test Results
Total number of test results submitted for each of the below:
UTP
F/UTP (Screened)
S/FTP (Shielded-TERA)
Fiber
* Total number of additional links/channels submitted for each of the below:
Additional UTP
Additional F/UTP (Screened)
Additional S/FTP (Shielded-TERA)
Additional Fiber
* Total number of relocated links/channels submitted for each of the below:
Relocated UTP
Relocated F/UTP (Screened)
Relocated S/FTP (Shielded-TERA)
Relocated Fiber
Reminder: Per CI Manual Normative 10-19: All PASS test results shall be downloaded into the database software that has been provided from the manufacturer of the field tester. Test results that are not submitted in the software format compatible with the field tester will not be accepted.
Horizontal Details Schematic
Does this project include a warranty for horizontal cabling? (If yes, the following table must be completed): *
Please enter the Siemon part numbers for each product into the fields below. These fields expand as you type or paste text into them.
A. Equipment Cord 1
B. Patch Panel/Connecting Block
C. Cross Connect Jumper/Patch Cord
D. Patch Panel/Connecting Block
E. Horizontal Cable Manufacturer
Hold CTRL to make multiple selections. Complete the manufacturer's part #'s in the appropriate fields.
E. Horizontal Cable Part Numbers (Siemon)
E. Horizontal Cable Manufacturer (If other)
E. Horizontal Cable Part Numbers (Other)
E. Horizontal Cable Part Numbers (Berktek)
E. Horizontal Cable Part Numbers (Essex)
E. Horizontal Cable Part Numbers (Mohawk)
F. Consolidation Point
G. Interconnect Cable Manufacturer
Hold CTRL to make multiple selections. Complete the manufacturer's part #'s in the appropriate fields.
G. Interconnect Cable Part Numbers (Siemon)
G. Interconnect Cable Manufacturer (if other)
G. Interconnect Cable Part Numbers (Other)
G. Interconnect Cable Part Numbers (Mohawk)
G. Interconnect Cable Part Numbers (Essex)
G. Interconnect Cable Part Numbers (Berktek)
H. Telecommunications Outlet/Faceplate
I. Equipment Cord 2
Note: All applicable fields are required to be completed for proper submission
Backbone Details Schematic
Does this project include a warranty for backbone cabling? (If yes, the following table must be completed): *
A. Equipment Cord/Fiber Jumper
B, D, F, H
Fiber Enclosure/Patch Panel/Connecting Block
Fiber Adapter
Fiber Connector
Fiber Splice
C. Cross Connect Jumper/Patch Cord/Fiber Jumper
E. Backbone Cable Manufacturer
Hold CTRL to make multiple selections. Complete the manufacturer's part #'s in the appropriate fields.
E. Backbone Cable Part Numbers (Siemon)
E. Backbone Cable Manufacturer (if other)
E. Backbone Cable Part Numbers (Other)
E. Backbone Cable Part Numbers (Berktek)
E. Backbone Cable Part Numbers (Essex)
E. Backbone Cable Part Numbers (Mohawk)
G. Cross Connect Cord/Fiber Jumper
I. Equipment Cord/Fiber Jumper
Note: All applicable fields are required to be completed for proper submission
Test Results *

Upload Test Results
Test Results are required for all submissions. All files must be consolidated into a single .zip or tester file prior to upload. Do not use the following characters in the file names: % ! # $ & ' ( ) * + , / : ; = ? @ [ ] Cancel of
Agreement
Feedback? (Optional)
If you have any issues or identify areas of improvement in this process, please let us know.
Should be Empty:

Warranty Registration Application

Warranty Change Application

Authorized Designer/Installer Information

End User Information

Installation Site

About the Project

Test Results

Horizontal Details Schematic

Backbone Details Schematic

Agreement