RADIOSHOPSUPPLY.COM
(760) 440-0125

Your Subtitle text
Service
RADIO REPAIR REQUEST FORM

Please complete this form and send it along with the radio being repaired.
If you are sending an item for repair, receipt of this completed form will expedite the repair process.
You will receive an RA# usually within 1 business day of submitting this form
FIELDS MARKED WITH * ARE REQUIRED!




WHEN COMPLETE HIT THE SUBMIT BUTTON AT THE BOTTOM OF THE PAGE.

First Name *:   
Last Name *:
 
Company:
Street Address*:
Apt / Suite:     City *:
State *:     Zip Code*:
Country*:      Phone Number:

Email Address *: 


                                                      RADIO INFORMATION

RADIO BRAND*:
RADIO MODEL NUMBER*:
RADIO SERIAL NUMBER*:

Description of Problem *:

RA#   ____________________ (Please Print after you receive number)

You will receive a RA# usually within 1 business day of submitting this form. Write in the RA # you receive in the space provied on the form. Please Include a copy of this form with your equipment.
 
ESTIMATE OPTION:
 After receiving your estimate, If you decide you don't want your equipment repaired there is only a $25.00 fee for estimate preformed plus return shipping & Insurance. If you decide to have your equipment repaired this fee will be wavied.

Estimate Requested:


RA#:  (Please Print after you receive number)  


AUTHORIZED SIGNATURE TO DO REPAIR OR ESTIMATE:
 


Print Here:_________________________________


Sign Here:
__________________________________


(Required)   Date:__________________


If Paying by credit card we Accept
Visa, MasterCard & Discover in the USA

For all international orders and repairs we process payments through PayPal.

We also accept Money Orders  & Cashiers Check
(NO PERSONAL CHECKS OR BUSINESS CHECKS)



Please Print this page before Clicking the Submit button



If more than 1 repair is needed please submit additional form(s).

                      

Website Builder