Repair Request Form

 

Please PRINT out and then complete this form and include it with your item(s).

 

Customer Information

Name………….... _____________________________________

Ship Address……_____________________________________

_____________________________________

City…__________________ St ___ Zip_________

Email Address..…_____________________________________

Phone – Days….._____________________________________

Nights…._____________________________________

Cell……._____________________________________

 

Shipping Information

Preferred Method

For Return …….. [ ] US Post Office [ ] UPS (check one)

 

Insurance

Requested ……. $_________

 

Repair Requested

Describe below the repair your item requires. Attach second sheet or use back of page if necessary. Do not rely on email or verbal instructions you may have given. Please be

specific and provide as much detail as possible. A drawing or sketch may also be helpful.

 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

 

Payment Method

Payment is due upon completion. For extensive repair, a deposit may be required.

 

[ ] Check/Money Order [ ] PayPal [ ] Other _____________ (check one)

 

Our Address

Ship your carefully packed item(s) to the following address. For multiple items, please include packing slip. Insurance is recommended.

For UPS or FedEx shipments ship to:
David Harr
65 Pierce Rd.
West Brookfield, Mass 01585
(508) 867-6603
For USPS shipments ship to:
David Harr
P.O. Box 1107
West Brookfield, Mass 01585-1107
Cell phone: (508) 472-4424