JVC RC-EX30BJ NAME:, CITY:, STATE, ZIPCODE, EXP. DATE, CREDIT CARD, ACCOUNT NUMBER, STREET ADDRESS:, METHOD OF PAYMENT, DAY TIME PHONE NUMBER:

WARRANTY REPAIR / REPLACEMENT FORM

PLEASE COMPLETE THE FOLLOWING;

PLEASE NOTE: P. O. BOXES ARE NOT ACCEPTABLE

NAME:STREET ADDRESS:

CITY:			STATE		ZIPCODE
DAY TIME PHONE NUMBER:
LABOR, S/H CHARGE	$	19.95		(FOR PRODUCT MORE THAN 90 DAYS, BUT LESS
				THAN 365 DAYS FROM RETAIL PURCHASE)
LOCAL SALES TAX	$
TOTAL PAYMENT	$

METHOD OF PAYMENT

CHECK OR MONEY ORDER ENCLOSED

CREDIT CARD ACCOUNT NUMBER EXP. DATE

VISA

MASTERCARD

DISCOVER

CARD HOLDER NAME	CARD HOLDER SIGNATURE
(IF DIFFERENT FROM ABOVE)

REASON FOR RETURN

BE SURE TO ENCLOSE COMPLETED FORM, A COPY OF YOUR BILL OF SALE, PAYMENT (IF APPLI- CABLE), SUPPLIED ACCESSORIES, TOGETHER WITH THE PRODUCT AND RETURN TO THE JVC REPAIR/REPLACEMENT FACILITY NEAREST YOU.

TO OBTAIN THE ADDRESS OF THE LOCATION NEAREST YOU <PLEASE CALL (800) 252-5722 OR VISIT OUR WEBSITE AT HTTP://WWW.JVC.COM

BT-51025-2

(0103) PRINTED IN CHINA