Camera repair form

Please Fill out and print the form, to send it with your equipment.

Thank You

Last Name

First Name

Business Name
Mailing Address

City:

State

Zip:

Phone

Home		Work:
Cell		Fax:

E-mail address:
Preferred Contact Method:	E- mail Home Work Cell Fax U.S. Mail

Model:

Serial #:

Accessories Included

We request you do not include any accessory items unless it is related to the problem / sevice requested.

A/V Cable

Battery

Battery Charger

Body Cap

CF/SD Card Size______

Charger

Lens Filter

Tape DV/8mm, Minutes______

Digital Connecting Cable Firewire/ USB

Eye Cup

Film

Front Lens Cap

Grip Strap

Lens Cap Holder

Strap

Problem / Service Requested

Leaving this section blank will delay your repair time.

Pre-Approve

Please repair or sevice my camera right away if the cost is at or below
$ We will contact you with an estimate if the cost exceeds the amount.

SEE CREDIT CARD INFO BELOW

Choose Payment

Visa MasterCard PayPal Check Money Order

Credit Card #

Exp Date /