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Repair Form - Sound& Video Department |
Repair Order Number |
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After Completing this page print 2 copies, send one with your item(s). |
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| Device Type | Model Number | ||
| Serial Number | Symptoms |
| Your Name | Email Address | ||
| Phone Number | Alternate Number |
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Payment Information - Please Read |
| A $25.00 payment is required for us to begin working on your item(s). If you wish to send in your payment with the item(s) to be repaired, please leave the credit card fields blank. If you prefer to use credit card but do not wish to send the information over the internet you can fill in the credit card information after printing this page and send it with your item(s). |
| Payment Type | Check, Money Order, Visa, Master Card | ||
| Card Number | Exp. Date | ||
| Name on Card | Billing Address | ||
| Return Address | |||
| Street Address | Apartment # | ||
| City | State | ||
| Zip Code | Comments | ||
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Print two copies of this page. |
Send one with your item(s) |
Keep one for your records. |
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SHIP TO: |
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| Please read the shipping instructions page for packaging instructions. |
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