CB Radio Repair Service Form

Multec Communications	Ship To: Multec Communications 319 Centre Ave. #166 Rockland, MA 02370 Attn: Service Dept.
CB Radio Tune-Up/Alignment Form


Please fill out form, print and include/ship with your unit.
Ship unit prepaid and insured via UPS or any shipper using a tracing or tracking system.
Pack Unit carefully!! It should be able to withstand a 3-4 foot drop onto concrete!

Payment Information
Credit Card Number	Expiration Date (mm/yy)	Name as Appears on Card

Note-If unable to pay using credit card include a Money Order deposit of $32.50. See #3 previous page.
Please provide the following contact/return shipping information:
Last Name		First Name
Organization
Address 1
Address 2
City		State/Prov
Zip/Postal		Country
Work Phone		Home Phone
E-mail		FAX


Please provide the following Unit information:
Manufacturer	Model Number	Serial Number

Accessories Included

Additional Comments:

Note: Form is PRINTED ONLY...No information is sent or stored.
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