DRONE REPAIRS NEW ZEALAND

Drone Repair Request Form
Drone Repairs New Zealand

205 Pollen St

Thames 3500

0275 986-345

dronerepairsnz@xtra.co.nz
Date*

DayMonthYear
Customer Information
Name*

First NameLast Name
Address*

Street

Street 2

ProvinceCity

Post Code
Email*
example@example.com
Phone Number
Please enter a valid phone number.
DRONE MODEL*
CRASHED? Has the drone crashed or had a hard landing?*

YesNo
Is the Drone Insured?*
Date of actual incident*

DayMonthYear
DRONE ISSUE (in your words)
In your words what is your drone doing or not doing, i.e. what is it's problem/problems?*
Initial Assessment Fee (non-refundable)*
prevnext( X )
Initial Assessment Fee (non-refundable)Initial Assessment Fee (non-refundable)
$150.00NZD

Freight (to return your drone to you)
$35.00NZD Quantity

Total

$0.00NZD
Please Pay *
KIWI BANK 38-9009-0463053-01
This is a fill in the blanks field. Please add appropriate blank fields and text.
Should be Empty:

Drone Repair Request Form