Equipment Repair Form
1. Customer Information
Customer Name
Contact Name
Phone Number
-
-
Shipping Address
Fax Number
-
-
City
Suite No.
Province
Postal Code
-
Department (if applicable)
2. Equipment Information
Model
Serial Number
Accessories Included
Battery
Antenna
Belt Clip
Charger
Other
3. Reason for Repair
Please check all that apply
No Transmit/Receive
Keypad
Static
Missing Buttons
Display
Distorted Sound
Antenna Connector
Battery Contact
Intermittent (describe)
Other
4. Form of Payment
Please check all that apply
Estimate Required
Yes
No
(if "No" please provide
Purchase Order Number)
P.O.#
A repair estimate will be provided automatically if repair exceed $150.
Maintenance Contract
Account
Cash
Credit Card
American Express
MasterCard
Visa
Credit Card Number
Exp. Date
__________________________
Signature
Customer shall pay for all repairs not covered by warranty.
5. Pick Up
Call when repair is ready
Ship when radio is ready
(a $20 shipping & handling fee charge will apply)
NOTES
_________________________________________________
Date (DD/MM/YYY)
Signature
Bring COMPLETED Form
along with equipment