Standard:
Repair covers cosmetics and equipment functionality.
Customer Number :
If this equipment was repaired by Barcode4Less within 90days then select YES, otherwise if unsure select
NO.
Under
Warranty :
Yes
No
Billing
Information
First
Name: *
Last
Name: *
E-Mail:
*
A RMA confirmation will be send to this e-mail address.
Company:
*
* denotes
required fields
Address:
*
City:
*
State:
*
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WASHINGTON, D.C.
WEST VIRGINIA
WISCONSIN
WYOMING Zip:
*
Phone:
*
Ext:
Fax:
*
Shipping
Information
(Check to use Billing Information:
)
First
Name:
Last
Name:
E-Mail:
Company:
Address:
City:
State:
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WASHINGTON, D.C.
WEST VIRGINIA
WISCONSIN
WYOMING Zip:
Phone:
Ext:
Fax:
Equipment
Information
Manufacturer:
Model:
S/N
:
Problem
Description :
Additional Billing and Shipping Information
Payment Method:
Pick One
Purchase Order
Credit Card
PayPal
Check or Money Order
Required for all repairs
Do you wish
to add an expedite fee of $35.00 per each repair for faster turn-around
(1 day turn around)
Yes, expedite my repair for an additional $35.00
No, don't expedite my repair for an additional $35.00
Return
Shipping method:
Pick One
UPS Ground
UPS 3 Day Select
UPS 2nd Day Select
UPS Next Day
FEDEX Ground
FEDEX Express Saver(3day)
FEDEX 2Day
FEDEX Standard Overnight
FEDEX Prioity Overnight
USPS Priority Mail
Other(specify in comments)
Comments:
Items with asterisks
represent required inputs. If you have any questions please call
Barcode4Less main office at 847-984-0097
.