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U.S. Electronics Repair Form Please copy and print the following form using your browser. Fill in the information, and enclose this form with your items for repair. We will be happy to give you a FREE ESTIMATE. Company ______________________________________________ Your Name ______________________________________________ Department ______________________________________________ Address _______________________________________________ City/State/Zip ______________________________________________ Your PO# _______________________________________________ Phone _______________________________________________ Fax ________________________________________________ Email ________________________________________________ Manufacturer _______________________________________________ Model Number ______________________________________________ Serial Number ______________________________________________ Description ________________________________________________ Problem _____________________________________________ Please attach any schematics, hook-up diagrams, or manuals you may have. Also, drives that use keypads must have their keypads attached. The more information you provide us, the faster and cheaper we will be able to repair your unit. Thank you! Please send to: U.S. Electronics Repairs
3700 Pennington Ave. (toll-free) 1-866-419-2250
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