Crown XLS Series - Crown Factory Service Information Form; Service Request Form Details

XLS Series Power Amplifiers
page 25
Operation Manual
Crown Factory Service Information
Shipping Address: Crown Factory Service, 1718 W. Mishawaka Rd., Elkhart, IN 46517
Phone: 1-800-342-6939 or 1-574-294-8200 Fax: 1-574-294-8124
Owner’s Name : _________________________________________________________________________________________________________________________________________________________________
Shipping Address: _______________________________________________________________________________________________________________________________________________________________
Phone Number: ________________________________Fax Number: ________________________________ Email ________________________________________________________________________________
Model: __________________________________________________________________________________ Serial Number: _________________________________________________________________________
Purchase Date : _________________________________________________________________________________________________________________________________________________________________
NATURE OF PROBLEM
(Be sure to describe the conditions that existed when the problem occurred and what attempts were made to correct it.)
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
Other equipment in system:____________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________
If warranty has expired, payment will be: ! Cash/Check ! Visa ! Master Card ! C.O.D. ! Purchase Order for Crown Dealer
Card Number:___________________________________ Exp. Date:___________________
Signature:______________________________________________________________________
ENCLOSE THIS PORTION WITH THE UNIT. DO NOT MAIL SEPARATELY.