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 stated on our website.

Customer Information:The following address is a Residence BusinessReturn ship signature required Yes $4.00 UPS fee* No *If Yes is selected UPS will not leave repaired equipment 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

(enter PayPal email here if different from above)

We will contact you for credit card information after we receive your equipment.

Special Instructions:

Please call 719-550-5810 if you have any questions or problems with this form.

Ship to:

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