Core E 400 - Factory Service Request Form

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CORE™ Outdoor Power
Authorized Service Request Form
Date:_______________________
Company or Institution Name [if applicable]:
_____________________________________________
Name of Purchaser [or name of contact person for Company or Institutionally-
owned product]:
________________________________________________
Physical Return Delivery Address
[Note: we are unable to deliver to PO boxes]:
Street Address:
________________________________________________
Address continued:
________________________________________________
City: _______________________, State / Province: __________________
Country [circle which applies] USA/Canada Zip/Postal Code: ___________
Correspondence mailing address [if different from delivery address]:
Street Address [or PO Box]:
________________________________________________
Address continued:
________________________________________________
City: _______________________, State / Province: __________________
Country [circle which applies]: USA / Canada Zip/Postal Code: __________
Daytime Phone Number: ____________________________
Extension: _________ Email Address: ____________________________
Mark (X) Your Preferred Method of Contact:
Phone ____, Email _____, Postal Mail _____
Date of original purchase: ___________________________