Lumen Photon Repair Form

Lumen Photon Therapy Repair Request
Full Name:*

First NameLast Name
Company
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail:*
Product Name*
Purchase Date*

MonthDayYear
Date
Please include the serial number located on the back of your controller:
Please Describe the Issue
Please Print your submission form now. Once you submit your form, the address for repairs will be provided. Thank you!
Should be Empty:

Lumen Photon Therapy Repair Request