Equipment Repair Request Form

Equipment Repair Request Form

Please fill out this form and submit prior to sending your equipment.
Request Date*

DayMonthYear
Date
Customer Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Equipment Information
ReproScan Model and Serial Number (if applicable)
Upload photos of the equipment that needs repair (if required/possible)

Cancelof
Date of purchase (approx.)

DayMonthYear
Date
Has the equipment listed above been repaired for the same issue previously?*

YesNo
Was the issue caused by accidental damage like water spill, equipment was dropped?*

YesNo
Description of problem and any notes or concerns*
IMPORTANT! Please note the following -
- Please clean eqipment prior to sending otherwise up to a $150 cleaning fee will be added.
- Please allow 7-10 days for your repair to be completed. If it will be longer than this - we will contact you. This would only be the case if special parts need to be ordered for your repair. We carry most common parts for all units in stock.
- Repairs require payment prior to returning. We have various payment methods available.
I have read the above points and acknowledge them*

Yes
Should be Empty:

Customer Information