Repair OR Return Merchandise Authorization Form
This is the official form for submitting any of the following issues with any of our devices:

1. Defective Unit
2. Functional Error
3. Broken Part/s
4. Part Replacement Order

If you are reporting an issue for more than one (1) unit, please submit a new form for each unit.
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Customer Name (Family Name, First Name, Middle Initial) *
Customer Address: *
Contact Number *
What unit are you having an issue with? *
If you answered "OTHER", please indicate the product name below:
Date of Purchase: (ACTUAL OR CLOSEST ESTIMATE) *
MM
/
DD
/
YYYY
Purchased From: *
If you answered "RESELLER or OTHER", please indicate the name of the reseller or the location where you purchased from below:
Delivery Receipt # :
Service Invoice / Official Receipt # :
Serial Number: *
What issue are you experiencing? Please check all that apply. If you are unsure, please describe the problem in "Other". *
Required
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