Bose Equipment Repair Form

The address at the bottom of this form can be cut off and used as an address label.
Complete then print this page and include it with your equipment.  Information entered here is not saved or downloaded to us.
Submission of this form constitutes acceptance of our terms and conditions as spelled out in our website.

Customer Information:
The following address is a   Residence    Business
Return ship signature required Yes $3.50 UPS fee*    No    *If Yes is selected UPS will not leave box without signature

Name
Company Name
Address
City State Zip
Phone#1     Phone#2 
Email

Equipment Information:
 
Model       We do not repair all Bose models, so make sure your model is listed on our site.
Serial #

Description of problems with equipment:

Payment Information:
Payment will be made by Check (10 day hold)  Credit Card  PayPal  Google Checkout  
We will contact you for credit card information after we troubleshoot your equipment.
Repairs are not completed without your authorization.

Special Instructions:


 

 

 

 

 

                    
 Ship to:

 Norbern Electronics Inc.
 719-550-5810
 6735 Earl Drive
 Colorado Springs, CO 80918-1055