RMA REQUEST FORM

Company name (optional):
Contact : *Last name: *First name:
*Address: Suite/Apt:
*City: *State: AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *Zip:
*Phone: Email:



Manufacturer: Model: ESN/IMEI:
# of batteries: # of chargers:

*Problem with phone: (hold down CTRL key to select more than one item)
no service fast busy no power drop call/static can't hear other person other person can't hear me keypad can't make outgoing calls can't receive incoming calls broken/missing antenna broken flip camera non-functional broken lens/plastics/caller ID unable to program display broken can't charge phone bluetooth problem

Comments:


Rush delivery: next day $15 extra    second day $10 extra

Please verify the above information is correct before submitting.