Estimate & Repair Request Form

Please provide the following contact information:

Full Name
Title
Street Address No P.O. Box, UPS will not Delivery
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City
State/Province
Zip/Postal Code
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Day time Phone
FAX
E-mail

Please provide the following product information:

Brand Name
Model Number
Serial Number

Any Accessories Included:

Tape BatteryAC AdaptorCaseLens CapIf Other, List below

Please describe the problem you are having:

Decided to send it in?

Instructions :

1. Print and complete this form.
2. Secure your equipment carefully in a box with suitable packing material to ensure   proper protection during shipping.
3. Include this form in the box.
4. Select a carrier that provides tracking information for the package.
5. Insure your package for the value of the product.
6. Ship your package to


    MYK CAMCORDER REPAIR SERVICE
    610 EAST CENTRAL RD.
    DES PLAINES, ILLINOIS 60016
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