Service Information Form
WHO IS RETURNING THE EQUIPMENT?
Person to contact:
Date:
Phone: ( )
Alternate contact:
Phone: ( )
Return shipping Address:
Special shipping instructions:
What is being sent?
Model number:
Serial number:
Please attach any relevant printouts when returning equipment.
Do not ship accessories that are not required to complete the repair (manuals, cleaning supplies, etc.).
WHAT NEEDS DO BE DONE?
1.Describe the conditions of the failure. (What was the failure? What were you doing when the failure occurred? What software were you running? Is the failure repeatable?)
2.If the failure is intermittent, how much time elapses between failures?
3.Is the unit connected to any of the following? (Give manufacturer and model number.)
Personal computer: | Modem: | Network: | Other: |
4. Additional comments:
HOW WILL YOU PAY FOR THE REPAIR?
❐ Under warranty | Purchase/received date : __________ Enclose proof of purchase or receiving |
| document with original received date. |
❐Maintenance contract number: ______________________________
❐Purchase order number: ______________________________________
Except for contract and warranty service, a purchase order number and/or authorized signature must
accompany any request for service. If standard repair prices do not apply, a minimum purchase order is required. Standard repair prices may be obtained by contacting an authorized Repair Center.
Authorized signature: ___________________________________ | Phone: __________________ | |
Billing address: | Special billing instructions: | |
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