PARTS FEEDBACK & WARRANTY FORM
 
  To our valued customer:

       We are always looking for ways to improve our service and your input is greatly appreciated. If you are dissatisfied for any reason with the condition of your shipment, please fill out this form. 		 
 
          Please fill out your contact information below to obtain required return authorization and to have your broken part replaced with an exchange unit. A customer service rep will contact you after receiving this form. All required fields are in bold.  
 
First Name:
 
  		Last Name:
 
 
Company Name :
 
 
Phone:(digits only)
 
 
Address :
 
  		City :
 
 
State :
Zip Code :
 
 
Email: (enter valid email address.)
 
 
Re-Enter Email:
 
 
 
  Contact Method: Call Me    Email Me
 
If you are a GBC tech or Authorized Service Rep please also fill out the information below:
Tech Rep # : PowerHelp Call# :
 
 
Your Purchase Order Number: 
 
 GBC Order Number:  
 		 Date: (mm-dd-yyyy)
   
 Model Number:  
 		  Serial Number: 
 
 Manufacturer of Model:  
 		  Invoice Number: 
 
 Purchase Date : (mm-dd-yyyy)
    		 Service Date: (mm-dd-yyyy)
   
 
 
Is there a problem with your shipment?     If yes, please fill in the information below.
WARRANTY STATE :  
For return of warranty part(s), please select your current warranty state.
Quantity Part # Reason
1.        
2.          
3.          
4.          
5.          
 
Reorder this part? How would you like it shipped?
 
MANDATORY Explanation: Use this section to explain why part doesn't work or why it is defective.