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Please print out this form and fill out applicable fields. Thanks
Name:___________________________________________________________________ Address:_________________________________________________________________ City, State, Zip:___________________________________________________________ Home / Work Phone:____________________________ Cell Phone:________________ Email Address:____________________________________________________________
Unit Information
Model:______________________________ Serial #:_____________________________ Brand:______________________________ Year & Model:________________________ Date of Purchase ( Only if your unit is still under Mfg. Warranty): _____________________ Included Accessories:_______________________________________________________ Please be sure to include copy of your receipt if under Mfg. warranty. Description of problem (please be as specific as possible): ________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Comment:________________________________________________________________
Ship to: Hi-Tech Electronic Services, Tel: (800)580-3376
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