Rotary Repair Authorization Form Section 1 - Contact Information* Indicates a required fieldCustomer InformationContact Name* First Last Phone*Email* Billing InformationCompany*Address*City*State*Choose a StateIllinoisIndianaZip*Shipping InformationShipping Information Use Billing information for Shipping Company*Address*City*State*Choose a StateIllinoisIndianaZip*Section 2 - Product IdentificationIndex/Rotary Model*Indexer/Serial #*Section 3 - Motor Identification Select which diagram matches your Rotary Cable Connector*7 Pin11 Pin14 Pin17 Pin28 & 7 PinSection 4 - Alarms & Reason for RepairRotary ControllerHaas Rotary Control BoxHaasDetailed ExplanationSpecial InstructionsSubmit your Rotary RANOTE: Haas Factory Outlet will contact you upon completion of the repair. Any rotary unit shipped collect will be refused. Ship To: Attention: Rotary Repair Department Haas Factory Outlet / A Division of HFO Chicago, LLC 165 N. Lively Boulevard Elk Grove Village, Illinois 60007NameThis field is for validation purposes and should be left unchanged.