CAD AUDIO Repair Request Form

Please fill out form completely, print and return with your repair


RETURN SHIPPING NAME AND ADDRESS:

Please Note: CAD AUDIO will not ship product to P.O. Boxes

Name:
Address:
City:
State:
Zip Code:
Contact Person:
Telephone (datytime):
Other Telephone:

CAD AUDIO DEALERS ONLY:


Acc #:
Ref #:

PRODUCT INFORMATION:


Product Model # / Serial #(if applicable):
Is the Product under warranty? No Yes
If “yes”, provide a sales slip or other proof of purchase date to validate warranty. All repairs without proof of purchase are considered out-of-warranty and will be charged.
Detailed description of the problem and any special instructions:
US Postal ZIP Codes where wireless products are used (if applicable):

CREDIT CARD PAYMENT INFORMATION (non-warranty repair only):


Method of Payment: Visa MasterCard Discover Daeler Account American Express
Number:
Expiration Date:
Security Code:
Name as it appears on card:
Credit Card Billing Address (if different from above):
*If you are tax exempt in the state of Ohio, please provide a copy of your tax exempt certificate with the repair. *You may request a “call for credit card”. Be sure you have provided a daytime telephone number.