Return/Service Request Form

Return/Service Request Form
Please Select ONE of the following *

Request for Repair / Service / Programming Replacement - Wrong Shipment Warranty Replacement - Defective Material Warranty Replacement - DOA (Dead on Arrival) Return for Credit (Restocking Fees May Apply) Trouble Ticket - (If this is urgent please call 800-283-COMM)
Technical Issue Type: *
Company Name *
Requestor Name *

First Name Last Name
Requestor Email *
example@example.com
Telephone Number *

Area Code Phone Number
Building Location / Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date and Time of Issue being Reported *

Month Day Year
Date Hour Minutes AM/PM Option
Please Describe in Detail What Happened *
Original PO Number or Invoice Number
Purchase Date

Month Day Year
Date
*
Additional Comments
Pick-up and Return Services
Pick-up and Return Services *
Pick-up and/or Return Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Billing Information
Address

Street Address

Street Address Line 2

City State

Zip Code
Billing Email Address
example@example.com
Are Quotes Required prior to Repair?
*There is a minimum evaluation fee of $75.00 if quote is declined.
Should be Empty:

Pick-up and Return Services