Repair Request Form
Your name and address
Your Name
Company Name
Address
City State Zip Code
Phone number ( ) Ext.
Product serial number
Unit(s) you are returning (check where applicable)
qTravelMate 3000 WinSX Computer qExpansion Station
q2 MB RAM Module Kit qSCSI Adapter
qNumeric Keypad qEthernet LAN Adapter
q80387SX Math Coprocessor qInternal Modem
qAC Adapter qInternal Battery
Type of Claim
qWarranty claim (attach proof of purchase)
qMaintenance contract (Agreement No. )
qMy purchase order number
qMy check is enclosed.
qCharge to my credit card. qMC q VISA q AMEX
Card Number Exp. Date
Description of Problem (attach extra sheet if necessary)