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
q2 MB RAM Module Kit
qNumeric Keypad
q80387SX 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 qVISA qAMEX

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Card Number Exp. Date
Description of Problem (attach extra sheet if necessary)