
SERVICE - WEST REQUEST FORM
CONTACT INFORMATION:
Phone:
Name: __________________________________________ Home ___________________________________________
Billing Address: Work ___________________________________________
________________________________________________ Cell ___________________________________________
________________________________________________ Fax ___________________________________________
Shipping Address:
________________________________________________ EMAIL: _________________________________________
________________________________________________
EQUIPMENT: Please list all equipment shipped to us and describe symptoms or work requested. Please specify if you believe any
of our services should be considered a warranty repair.
1) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
2) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
3) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
4) _______________________________________________________ Serial Number __________________________
Work Request: ____________________________________________
SCHEDULING: You will receive a free estimate by phone or email within ten days of receipt. Most repairs are completed within
three weeks from your estimate approval. Please note that delays could happen due to lack of parts or during peak times. Please note
your next trip date below for completion. IF YOU REQUIRE RUSH SERVICE YOU MUST CALL FOR SCHEDULE APPROVAL.
My next trip date: Check if RUSH only: ___ I have called and confirmed a RUSH schedule
___ I approve the quoted RUSH fee maximum charge
PAYMENT AND ESTIMATE APPROVAL: If your trip date is within four weeks, we recommend you expedite the repair by pre-
approving service fees. If our technicians determine the fee will exceed your pre-authorized amount, we will send an estimate for your
approval. ALL RUSH REPAIRS MUST BE PRE-AUTHORIZED. SHIPPING FEES ARE NOT INCLUDED IN REPAIR ESTIMATES.
ESTIMATES.
___ Please begin work immediately if fees are less than $ ________________________________
Bill my credit card: (circle one) MC / VISA / AMEX / DISC ______________________________
Expiration Date ________________________________
___ Please email, fax or call for my approval
COMMENTS:
22740 Portola Drive
Salinas
CA 93908 831-484-6233 service
suba
uaticcamera.com