MILTRONICS REPAIR ORDER REQUEST FORM
For all questions/concerns, please contact us at (973) 471-7700 or hend@miltronics-inc.com
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Your Company Name *
Please provide your company name? (*B2B only)
Your Company Office Location *
Please provide your company office location? (City, State) [ie. Company Name: Miltronics Location: Clifton, NJ]
Your Name *
Please provide your name.
Email address
Your Email address if available (**OPTIONAL**)
Your Phone Number *
Job Address? *
Will this be a drop-off, pick-up or shipment? (Please select one) *
Required
Pick-Up Address/Location? (**OPTIONAL**)
Shipment Tracking #  (**OPTIONAL**)
Type *
Please check off category of items sent for repair
Required
Mfg./OEM & Part Number *
Please provide Brand name & Part Numbers sent for repair i.e. Magnetek P/N HPV900-2075-2E101
Describe the issue/problem with items sent for repair *
Do you have any other requests? (**OPTIONAL**)
Rush, non-rush, stock? *
Submit
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