CRJ 3850 Holcomb Bridge Rd. Suite 150

Peachtree Corners, GA 30092

Repair Form Please include this form with all repair inquiries. Name:

Address: City, State, Zip:

Phone (Day) (Evening)

Email: Fax:

*Please include your email address or fax#, otherwise, estimates are mailed to your address Equipment 1: Serial No.

Equipment 2: Serial No.

Equipment 3: Serial No.

Equipment 4: Serial No.

Note: Serial Numbers are generally located on the bottom or back covers of most items

Please circle any accessories that are being sent with the repairs. Battery Lens cap Viewfinder Strap Case

Filter Film Tape Body cap Memory card Size:

Other: *Please do not send any accessories that is not related to the problem. Problems/Notes:

If items are under warranty, please include a copy of the proof of purchase. Pre-Approved Amount: $ + Shipping

Visa Mastercard American Express Discover Card No: Exp Date: / You may or may not fill in “Pre-Approved Amount”. If the cost of the repair exceeds the Pre-Approved amount, and estimate will be sent regarding the repair costs.

Any questions, please call 1-888-226-6678 or 770-849-0555 or visit www.camerarepairjapan.net CRJ reserves the right to dispose of any equipment that is left in our facility with no response

for more than 120 days