*First Name:
*Last Name:
*Street Address:
*City:
*State:
Country:
*Zip Code:
*Email Address:
*Phone Number:
Alternate Phone:
*Manufacturer:
*Model No. (type):
*Serial Number:
Description of the repairs required:
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Please Note:
While we handle all our shipments when they arrive with the utmost care we are not responsible for any blemishes, scratches nicks, dents or dings that may occur in shipment. We highly recommend the shipper insure their package(s) for what you believe is the value of your shipment.  Please assume responsibility for your shipment and package it properly.  All packages will be insured for the stated value when returned. All packages being shipped from our facility will be packaged carefully to minimize any damage that may occur during the return shipment.
*Stated value of your Shipment:
Calculate the cost of shipping here at UPS:
(*) denotes required field.
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