7049 Valjean Ave.              Tel: 818-785-8085
Van Nuys, California 91406        Fax: 818-782-5939

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Home Shipping Form
Shipping Form
  1. Please fill out, print this form and attach it to your unit before shipping.
  2. Company Name
    Please type your company name.
  3. Last Name(*)
    Please type your last name.
  4. First Name(*)
    Please type your first name.
  5. E-mail(*)
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  6. Cell Phone Number(*)
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  7. Home phone
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  8. Work Phone
    Please type your Work Phone and Extension number.
  9. Address(*)
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  10. City(*)
    Please type your city name.
  11. State
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  12. Zip Code(*)
    Please type your zip code.
  13. Country
    Please type your country name.
  14. Today's date(*)
    Please enter today's date.
  15. Unit Information
  16. Model Number
    Please type the model number of your unit.
  17. Serial Number(*)
    Please type the serial number of your unit.
  18. Vehicle Make & Model
    Please type the make of your vehicle.
  19. Vehicle Year
    Please type the year of your vehicle.
  20. Problem Description or Comment(*)
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  21.   Please print the form before submission.
  23. Ship to:

    Hi-Tech Electronic services
    7049 Valjean Ave.       Van Nuys, CA 91406
    Tel:(818)785-8085    Fax:(818)782-5939

    Email: service@hitechserv.com