Equipment Repair Form - Grand Rapids Technologies

EQUIPMENT REPAIR FORMDATE: / /COMPANY NAME *:ORCONTACT PERSON *:TELEPHONE *: ( ) __ - & EMAIL *: _BILLING ADDRESS *:CITY *: STATE *: _ZIP CODE *:**PLEASE NOTE: GAND RAPIDS TECHNOLOGY WILL SHIP TO P.O. BOX ADDRESSES**SHIP TO ADDRESS IF DIFFERENT FROM ABOVE:ADDRESS:CITY: STATE: _ZIP CODE: _PAYMENT: VISA/MC/DISC./AMX#__ CALL FIRST IF REPAIR IS OVER $CVC CODE:_EXP DATEPROVIDE A BRIEF, DETAILED DESCRIPTION OF THE PROBLEM WITH YOUR UNIT AND ANYSPECIFIC PARTS YOU WOULD LIKE REPLACED. WE WILL PROVIDE AN EVALUATION ANDESTIMATE BEFORE ANY WORK IS DONE.IF RETURNING PRODUCT(S), INCLUDE A COPY OF YOUR PURCHASE RECEIPT.*********TECHNICIAN REPORT*********QTY ITEM # WORK DONE PRICINGPLEASE COMPLETE ANY FIELDS MARKED WITH A * AND SHIP TO THE FOLLOWING ADDRESSGRAND RAPIDS TECHNOLOGIES, INC., ATTN: YOLANDA KRYGER3133 MADISON AVE., WYOMING, MI 49548▪ (616)-245-7700 Fax (616)-245-7707EMAIL: yolanda@grtavionics.com

Dear Customer,Grand Rapids Technologies / GRT Avionics would like to thank you for yourbusiness.We are sorry to hear that you have been experiencing problems with yourproduct.Carefully package the unit and send it to us, our technicians will put itthrough a thorough examination to determine the source of the problem.If the problem requires a minor repair or is under warranty, we shall makethe repair and be sure to return the product to you within one to five days.If our determination is that a change is required, we will contact youregarding the amount.Again, we are sorry that you experienced this difficulty and wish to thankyou for your patience and for purchasing our product.PLEASE REFER TO FOLLOWING INSTRUCTIONS BELOWPRINT THE EQUIPMENT REPAIR FORM AND DO THE FOLLOWING1. FILL OUT THE REPAIR FORM (FIELDS MARKED WITH AN (*) ARE REQUIRED)2. FILL IN PAYMENT INFORMATION3. SHIP THE UNIT AND REPAIR FORM TO:GRAND RAPIDS TECHNOLOGIES, INC.,ATTN: YOLANDA KRYGER3133 MADISON AVE, WYOMING, MI 49548(616) 245-7700 Fax (616) 245-7707(UPS, FEDEX AND USPS ARE ALL ACCEPTABLE FORMS OF SHIPPING)4. IF LOCAL, DROP-OFF AND PICK-UP OF UNIT CAN BE ARRANGEDRETURN AUTHORIZATION NUMBERS ARE NOTREQUIRED. PLEASE WRITE LEGIBLY ANDNEATLY.Grand Rapids Technologies, Inc. | 3133 Madison Ave. | Wyoming, MI 49548-1211 | PH (616) 245-7700 | FAX (616) 245-7707