U.S.A Repair Form

Please Note - When entering your telephone number, please just enter numbers only such as 5622132662 NOT (562)213-2662 or any other variation as this will result in an error.

Thank you for your submission.

Contact Information

Department Name:*

Address:

Address 2:

City:*

State:*

Zip Code

Contact:*

Email:*

Phone number:*

Fax Number:

Product Information Please fill in the following to let us know about the item you will be shipping to us.

Manufacturer:

Model:

Serial Number:

Unit under warranty?

Description of the problem:

Shipping information:

Decatur policy is to repair, invoice and ship all jobs that are under $150 without prior estimates. Declined repairs are subject to minimum evaluation and shipping fees. If you would prefer us to contact you prior to performing the repair, please check the box below.

Require estimate and get approval prior to repair.

Please enter the PO number or enter "none" and check the box below verify that you do not need one prior to submission of this repair.

P.O:

Our department does not require purchase orders

Billing Information (if billing information is different than contact information)

Department Name:

Address:

Address 2:

City:

State:

Zip Code:

Email: