Bose Equipment Repair Form

The address at the bottom of this form can be cut off and used as a shipping label.
Complete then print this page and include it with your equipment.
Information entered here is not saved or downloaded to us.

Customer Information:
The following address is a   Residence    Business
Return ship signature required Yes $3.00 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  
Serial #

Description of problems with equipment:

Payment Information:
Payment will be made by Check (10 day hold)  Visa / MC  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