The DJL Advantage | Digital Video Recorders | Medical Video Equipment | Video Projectors | Refurbished Equipment | Unrepaired Equipment | Maintenance Tips | Equipment Repair Form | Image Enhancement | Shipping Guidelines

Equipment Repair Form

Contact Information:

Company
Name

Shipping

Address

Billing

Address

Equipment Information:   (Please use one form for each piece of equipment)

Brand

Serial No.

List of
Accessories

Special
Instructions

Warranty Repair?

YES

NO

Proof of Purchase Enclosed?

YES

NO

Shipping Instructions

• Use a sturdy box with 2-3 inches of protection between the equipment and the box.
  

• Do not pack heavy equipment in Styrofoam "peanuts".
  

• If peanuts are used, wrap equipment in plastic bags to keep peanuts from entering the equipment.
  

• If warranty repair, enclose a copy of the original invoice.
  

• Enclose this form in box with equipment to be repaired.
  

• Use one form for each piece of equipment to be repaired.
  

• Insure contents with your carrier.  Equipment can be damaged in route.
  

Telephone

Email

PO#

Contact Name

Billing Method

Bill w/approved credit 

Credit application enclosed

COD       

Visa/MasterCard         

American Express

FAX:

Description of Problem

Model