Date:_____________
10752 Noel St., Los Alamitos, CA 90720
Phone (800) 385-1575 Fax (714) 527-0640
Dealer:________________________
Fax#:__________________________
Sent In by:_____________________
OFFICE USE ONLY
R.A. Request #____________________
Approval:______________
Please print all information
quantity
Brand & model
Serial #
Complete: YES______ or NO_____
Description of problem
Exchange: _____ or Service _____
Please print all information
quantity
Brand & model
Serial #
Complete: YES______ or NO_____
Description of problem
Exchange: _____ or Service _____
Please print all information
quantity
Brand & model
Serial #
Complete: YES______ or NO_____
Description of problem
Exchange: _____ or Service _____
Please print all information
quantity
Brand & model
Serial #
Complete: YES______ or NO_____
Description of problem
Exchange: _____ or Service _____
Please print all information
quantity
Brand & model
Serial #
Complete: YES______ or NO_____
Description of problem
Exchange: _____ or Service _____
Please print all information
quantity
Brand & model
Serial #
Complete: YES______ or NO_____
Description of problem
Exchange: _____ or Service _____
Comments:____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please fax back upon completion to (714) 527-0640.
Allow 5 business days for reply with RA #. THANK YOU.