Service Request from Customer

Hello! We will gladly get in touch with you to help resolve your service issue. Please fill out the below info with as much detail as possible. Please be patient for a response, Michelle our service department manager will be in touch as soon as she can.

(OFFICE USE ONLY) SOS#
Customer name the order would be listed in our system Customer name the order would be listed in our system First Last
Address the order would be listed in our system Address the order would be listed in our system
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Text friendly cell phone # Text friendly cell phone # - ### - ### ####
Customer email
How do you prefer to be contacted about the service issue?
Item(s) with issue including model or SKU# if known.
Maximum of 50 words allowed. Currently Entered: 0 words.
Estimated date of purchase? Estimated date of purchase? / MM / DD YYYY
(OFFICE USE ONLY) Has date of purchase above been verified?

(OFFICE USE ONLY) Has date of purchase above been verified? Yes If not correct what is correct date?
Please BRIEFLY explain the issue.
Maximum of 250 words allowed. Currently Entered: 0 words.
Please give us a picture of the entire item standing back

Attach Files
Please give a close up picture of the specific issue(s)

Attach Files
Please give any additional photos to help us see the service issue(s)

Attach Files
Please take picture of any tag or label on item

Attach Files
Did you purchase the protection plan at time of sale?
(OFFICE USE ONLY) Has protection plan answer above been verified?

(OFFICE USE ONLY) Has protection plan answer above been verified? Yes If not correct what is correct answer?
Todays date Todays date / MM / DD YYYY
Name of person filling out this form. Scroll to bottom to SUBMIT. Name of person filling out this form. Scroll to bottom to SUBMIT. First Last
(OFFICE USE ONLY)
Description
Vendor
Model #
Bar Code
PO #
Finish/Cover
SKU #
Factory Invoice #
Acknowledgement #
Serial #
Original Salesperson