INLINE (4/5/6) Adapter Repair Form Please choose one of the following failure modes:

Unit not communicating – All Lights Stay ON Unit not communicating – No Lights ON Unit not communicating – Only Power Light ON Other (Please explain below)

Name:___________________________ Date:_____________ Adapter Serial Number (S/N on back barcode label): __________________ Distributor or Branch locations may send adapters (Not the Entire Kit) in need of repair to: Cummins Inc. 1460 National Road Columbus, IN 47201 Location 38 Attn: Lee Shipman Create unique identifier for ATTENTION field following the format below. CU- Month Number (i.e. 6 = June) and Last two digits of year (i.e. 07 = 2007) and your Dist Code Att: CU-6-07-02840 and place your name there is different from above. In the example above, June of 2007 Cummins Mid-America returned this adapter. ----------------------------------------------------------------------------------------------------------- RETURN ADAPTER TO: Company: Cummins___________________________________ Address:_____________________________________________ City:_____________________ State:_____ Zip:_____________ Attention:_____________________________________________ Contact: ______________________________________________ Email or WWID:________________________________________ Phone Number:________________________________________