Ship To:
Company Name
*
Point of Contact
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Bill To
Company Name
*
Point of Contact
*
PO Box or Street Address
*
City
*
State
*
Zip
*
Radio Unit Information
Manufacturer
Model #
Serial #
Accessories Included
Battery
Antenna
Speaker Mic
Headset
Charger
Power Supply
Side Cover
Belt Clip
Strain Relief
Other, please describe
Symptoms
No/Low Power
No Receiving
No Transmit
No/Low Audio
Battery Problem
Dead
Intermittent TX / RX
Constant Tone
Damage
Volume Control
Needs Reprogrammed
Broken Belt Clip
PM Check
Other, please describe problem
Do you need an estimate before a repair is made?
Yes
No
Return Method
UPS Ground / Collect
Customer Pick-Up
FedEx Ground / Collect
Ups Collect #
FedEx Collect #
Date
*
Please verify that you are human
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