Repair Form Iv - United Radio
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1REPAIR FORM
Dealer/Business Section
End User Section
TODAY’S DATE _________________ REPAIR # ________________
TODAY’S DATE: ______________________________
STORE NAME ___________________________________________
NAME: ________________________________________________
ADDRESS ______________________________________________
ADDRESS: ____________________________________________
_______________________________________________________
______________________________________________________
CITY:___________________________________________________
UR ACCT #______________________________________
STATE:__________________ ZIP: __________________
YOUR CONTACT PERSON ________________________________
DAYTIME CONTACT PHONE # :(________) ________-_____________
STORE PHONE # ________________________ EXT. ___________
OTHER PHONE #: (________) ________-_____________
EMAIL _________________________________________________
EMAIL ADDRESS: ________________________________________
We will send you regular email updates on the status of your repair
CUSTOMER’S NAME* ___________________________________
and will not sell it to any other organization or market to you.
ADDRESS*___________________________________________
PLEASE CHECK ONE APPLICABLE BOX :
MANUFACTURER’S PARTS & LABOR WARRANTY*
____________________________________________________
* Copy of Bill of Sale required. Manufacturer requires
(
)
Customer Name,Full Address including Zip Code, and
CUSTOMER’S PHONE # *_______________________________
Phone Number
* Required by manufacturer for all Warranty Repairs
OUT OF WARRANTY - Approval of URS Standard
Repair Cost or
depending on equipment
Estimate,
BRAND ________________________________________________
type and replacement of boards or complete
assemblies, will apply.
MODEL # ____________________ SERIAL # ___________________
$40 fee for No Trouble Found units applies.
DATE OF PURCHASE _____________________________________
Bill our UR Open Account
PRE-AUTHORIZATION # __________________________________
Call for Credit Card (MasterCard, Visa, AmEx)
Failure to check appropriate box will delay repair of unit
Return COD ($11 COD fee applies)
while we contact you to obtain information!
EXTENDED WARRANTY - Pre-authorization from
extended warranty company required.
( dents, scratches, etc)
PLEASE DESCRIBE CONDITION OF UNIT
________________________________________________________
____________________________________________________________________________________________
ACCESSORIES INCLUDED:
___________________________________________________________________________________________________________________
P
lease give a detailed description of the symptoms being experienced with this product (eg: Low,
scratchy volume on the left side only after playing for 5 minutes.) What is seen and heard?
___________________________________________________________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________________________________
PLEASE REFER TO THE SHIPPING INSTRUCTIONS ON THE SHIP IN PRODUCT PAGE TO INSURE THAT THE
UNIT ARRIVES SAFELY AT OUR DOOR. SHIPPING COSTS AND INSURANCE ARE THE CUSTOMERS RESPONSIBILITY.
Check your job status at
(315) 446-8700
(800) 634-8606
Click on Check Repair Status
5717 ENTERPRISE PARKWAY
FAX (315) 445-3297
EAST SYRACUSE, NY 13057
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Parent category: Business