Customer Repair Form

PLEASE COMPLETE THE FORM BELOW PRIOR TO SHIPPING YOUR EQUIPMENT TO ECHOMETER COMPANY FOR REPAIR. PLEASE NOTE THAT REPAIRS WILL BE EXPEDITED WHEN WE HAVE THIS INFORMATION. NOTE: PLEASE DO NOT INCLUDE ANY CREDIT CARD OR WIRING INFORMATION FOR SECURITY PURPOSES

Company Name: *
Person Authorizing Repairs: *
Office Phone:
Mobile Phone:
Email Address:

PLEASE LIST ALL EQUIPMENT AND/OR ACCESSORIES YOU ARE SHIPPING TO ECHOMETER (INCLUDE SERIAL NUMBERS):

SOFTWARE CURRENTLY BEING USED (PLEASE INCLUDE RELEASE DATE OR VERSION):

TWM:		Release Date:
TAM:		Version:

Return Shipping:
METHOD :	Will ship UPS Ground unless otherwise specified
Address 1: *
Address 2:
City:
State:
Zip Code:

NOTE: *IF REPAIRS ARE TO BE BILLED TO A COMPANY OTHER THAN LISTED ABOVE, PLEASE INCLUDE THEIR BILLING ADDRESS AND A CONTACT NAME.

Billing Information:
Address 1:
Address 2:
City:
State:
Zip Code:

PURCHASE ORDER NUMBER, CHARGE CODE, PAYKEY AND/OR ANY OTHER INFORMATION YOUR COMPANY REQUIRES FOR PAYMENT OF INVOICES:

ADDITIONAL PARTS OR SUPPLIES TO ORDER:

REPAIRED EQUIPMENT WILL BE RETURNED BY UPS/GROUND UNLESS CUSTOMER REQUESTS OTHER MODE OF SHIPMENT. EQUIPMENT BROUGHT IN FOR REPAIR DURING A SEMINAR WILL BE SHIPPED IF REPAIRS ARE NOT COMPLETED BY THE END OF THE SEMINAR.
Comments / Instructions:

Type the above number:

Echometer Company
Repair Department
5001 Ditto Ln
Wichita Falls, TX 76302