REPAIR FORM
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  Today's Date __________

Your Name __________________________________
Address_____________________________________
___________________________________________
___________________________________________

Daytime Phone #(_____)__________ Ext.______

Brand_______________________________________
Model #______________ Serial #_________________
Please Describe Condition of Unit (ex. dents,
scratches, etc)______________________________
_________________________________________

Accessories Included (Please send only
those accessories needed for repair or
basic operation)___________________________
_______________________________________
_______________________________________

   Store Where Purchased _______________________
Date Purchased________________________________


Please check one applicable box below:

___ Out of Warranty - URS Limit or Flat Rate applies
___ Parts Warranty Only* - URS Limit or Flat Rate applies - Copy of Bill of Sale required.
___ Manufacturer's Parts & Labor Warranty - Copy of Bill of Sale required.
___ Extended Service Contract - Pre-authorization from extended warranty company required

Please give a detailed description of the symptoms you are experiencing with this product (ex: Low, scratchy volume on the left side only after playing for 5 minutes.)








Tips to help speed the repair process:
Check this list and be sure to include:

____ Detailed description of symptom(s)
____ If under manufacturer's warranty, include a copy of your receipt
____ If out of manufacturer's warranty, pre-approve the limit or flat rate for item
____ If extended warranty, contact the extended warranty company for a pre-authorization