Repair Authorization Form 
Repair includes all parts and labor, 180 day warranty, our lifetime* keypad warranty but does not include replacing broken or missing housing parts or LCD displays.
 

Your RA Number:

  DRP (plus the last 4 digits of your phone number) Example: DRP1212
 
 

Return Shipping Address

 Bill to address (if different)
Name:
Company:
Address:
City, State, Zip
REQUIRED
PHONE NUMBER:

EMAIL ADDRESS:
QTY MODEL PRICE

TOTAL LINE PRICE

KX-TGA200b 2-line

 $39.99 ea

KX-TGA400b 4-line

 $39.99 ea

KX-TGA420b Desk Phone

 $42.99 ea

KX-TG2000b / KX-TG4000b BASE

 $75.00 ea
Please add a new battery at a discount with repair
($7.95 Handsets and Desk Phone) -  ($19.99 Base unit)
Please make my phone look new for $29.95 ea. (cordless handsets only)
Please RUSH my order for $10 per phone
Please list any additional requests or items you may need, Displays, Antennas, etc..

(This is just an estimate)     TOTAL:
Return shipping:  
Circle one: US Priority Mail  -   UPS Ground  -  UPS 3-Day orange  -  UPS 2-day Blue  -  UPS Red Overnight
Visa, MC, AMEX, Discover  Card billing address must match billing address listed above!!
CC# Expiration (MM/YY):  

Name on card:                CSV Code: