Equipment Repair Form

The address at the bottom of this form can be cut off and used as a shipping label.
Please complete then print  this page and include it with your equipment.
Information entered here is not saved or downloaded to us.

Customer Information:
The following address is a   Residence    Business. This is the address we will return ship to.

Name
Company Name
Address
City StateZip
Phone#1 Phone#2
Email

Equipment Information:
 
Make Model
Serial #

Description of problems with equipment:

Payment Information:
Payment will be made by (select one)  Visa / MC   Google Checkout  PayPal    Check or Money Order
We will contact you for credit card information after we troubleshoot your equipment.
Repairs are not completed without your authorization.

Special Instructions:


 

 

 

 

 

 

 

Ship to:   Norbern Electronics Inc.
                      6735 Earl Drive
                      Colorado Springs, CO   80918
                      (719)550-5810