External Capture Form
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Application:
SLI
Store Number:
Contact Person:
Phone Number:
Phone Extension:
Address 1:
Fax:
Address 2:
Email:
City:
Customer Number:
AS0001
Zip Code:
Customer Name:
Batteries Plus Bulbs
Country:
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
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Iran
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Mali
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Mauritius
Mayotte
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Mozambique
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Nauru
Nepal
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Netherlands
New Caledonia
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Nigeria
Niger
Niue
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North Korea
Norway
Oman
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Panama
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Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
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Samoa
San Marino
Sao Tome & Principe
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Slovakia
Slovenia
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Somalia
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South Georgia
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Sweden
Switzerland
Syria
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Tajikistan
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Thailand
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Tunisia
Turkey
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United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna
Yemen
Zambia
Zimbabwe
<select>
Date Warranty Received:
State:
<select>
Alabama
Alaska
American Samo
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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South Carolina
South Dakota
Tennessee
Texas
UT - Utah
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Not Applicable
Battery Information
Part Number:
<select>
NSB AGMG24
NSB AGMG24F
NSB AGMG27
NSB AGMG27F
NSB AGMG31
NSB AGMG31A
NSB AGMG34
NSB AGMG34/78
NSB AGMG35
NSB AGMG48 (L-3/H-6)
NSB AGMG94R (L-4/H-7)
NSB AGMG65
NSB AGMG78
NSB AGMG24M
NSB AGMG27M
NSB AGMG31M
NSB AGMG34M
NSB AGMG65M
SMS-G8DK
SMS-G8DK-S
NSB-G8DK-DT
NSB AGMG24K
SMS-G80
SMS-G220
SMS-G400
SMS-G480
NSB AGM N7500
NSB AGM G31 ACE
NSB G8D-S
Serial Number:
Purchase Date:
Application Battery was In:
Customer Comment:
Visual Inspection
Case Condition:
Good
Swollen
Cracked/Broken/Damage
Terminal Condition:
Clean
Corroded
Damaged
Tester Data
Tester Make:
<select>
Auto Meter
B2Q
Midtronics
Other
Tester Model:
<select>
Shallow and deeply discharged X2 Power Blue Top batteries are often recovered with a 20 – 60 amp charge for two to four hours. The charger should be approved for AGM batteries to prevent excessive charging voltage that will damage the battery.
(Consult Ascent for recommended chargers)
OCV as Received by Customer:
(Open Circuit Voltage)
OCV after Recharge:
Charger Used:
Current Used (Amps):
Recharge Time (Hours):
Test Results:
Hidden fields
Claim Date:
Files
(Anonymous)
i-Sight by Customer Expressions