Repair Authorization Form      Base unit repair $72.25 each
Repair includes all parts and labor, 90 day warranty, 5-year keypad warranty but does not include replacing broken or missing housing parts or LCD displays.
You can type on this screen right now! Or print and use later (with clear hand writing!!)
Phone number, email address and credit card information is REQUIRED!

Your RA Number:

 DRB Hit Counter
 

Return Shipping Address

 Bill to address (if different)
Name:
Company:
Address 1:
Address 2:
City, State, Zip
PHONE NUMBER:EMAIL ADDRESS:
QTY MODEL PRICE EACH

TOTAL LINE PRICE
$72.25
$72.25
Please RUSH my order for $10 per unit

TOTAL:
Return shipping: Shipping cost varies by location
Circle one: US Priority Mail  -   UPS Ground  -  UPS 3-Day orange  -  UPS 2-day Blue  -  UPS Red Overnight

 
 Card billing address must match billing address listed above

CC# Expiration (MM/YY):  

Name on card:                CSV Code: