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| First name: |
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Last name: |
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| Phone: |
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| E-mail address: (*) |
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*
We strongly recommend providing e-mail addresses.
E-mail will remain private. |
| Address 1: |
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| Address 2: |
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| City: |
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State: |
ZIP: |
| Model: |
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Serial #: |
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Problem:
(if you need more
space, write on the back) |
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Warranty |
All warranty
repairs MUST have a copy of the Dated Proof
of Purchase. Warranty does not apply if product has been damaged by
accident or abuse (see limited warranty agreement). |
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Non-warranty |
Estimates
will be mailed to you. No repairs will be done without your
authorization.
If you would like to PRE-APPROVE your repair, please fill out the
box below. |
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| Pre-Approve |
Please
repair my camera if the cost is at or below
Notify me if the cost exceeds this amount. |
$ |
| Name on credit card: |
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Credit card type: |
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| Credit card number: |
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Expiration Date: |
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