Repair Request Form
Personal Information
First Name*
Last Name*
Company Name*
Email Address*
Phone Number*
Address 1*
Address 2
City*
State*
Zip Code*
Country*
Product Information
Product 1
Fill one out for each product repair
Product 1*
Serial Number 1* Battery: Located underneath Battery (XX-YYYY-ZZZZ)
Machine: Remove Grip, Located on Spline (XX-YYYY-ZZZZ)
Power Supply: Located underneath unit on label
If not present, type N/A
Product 1 Purchase Date*
Pick
What best describes your issue with the product?* Select all that apply
Where did you purchase your product?
Product 2 (optional)
Fill one out for each product repair
Product 2
Serial Number 2 Battery: Located underneath Battery (XX-YYYY-ZZZZ)
Machine: Remove Grip, Located on Spline (XX-YYYY-ZZZZ)
Power Supply: Located underneath unit on label
If not present, type N/A
Product 2 Purchase DatePick
What best describes your issue with the product? Select all that apply
Where did you purchase your product?
Product 3 (optional)
Fill one out for each product repair
Product 3
Serial Number 3 Battery: Located underneath Battery (XX-YYYY-ZZZZ)
Machine: Remove Grip, Located on Spline (XX-YYYY-ZZZZ)
Power Supply: Located underneath unit on label
If not present, type N/A
Product 3 Purchase Date
Pick
What best describes your issue with the product? Select all that apply
Where did you purchase your product?
Additional Comments(Incoming Message) * Provide as much detail as possible
"Repair Ticket Critical"
Upload Picture and/or Video Uploaded files can be up to 10 MB in size.File type. .mov/jpg/mp3/pdf/html/excel/powerpoint
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