MONITOR DEPOT, INC         

5359 West Richey Road  Houston,  Texas  77066    

CALL:  (281) 580 - 5656     After Hours  (281)  450 - 1064    

 

 

FLAT PANEL LCD TV REPAIR FORM

Note:  Print this form and then complete by hand.

STEP 1:  Ship to Information:    

 

Name:   _________________________________________________________

Attn:   ___________________________________________________________

Street:___________________________________________________________

City: ____________________________, St __________ Zip_______________

Check:          Residential              OR        Commercial       Address

Tel:  ( ____ )    ______    -    _______    

E-mail:______________________________________________  (print clearly)

Unit Brand & Model #        ____________________________________________

SN:   ____________________________________________________________  

Problem  description:   ______________________________________________

________________________________________________________________

RMA #   issued     ______________    

Include:          Remote        Outside Power Supply  (if it has one)

Insurance value you would like for return shipping (if any)    $   _____________

You can use the following for our shipping address if it is easier for you: 

 

             Ship to:     MONITOR DEPOT, INC

                       5359 WEST RICHEY ROAD

                       HOUSTON, TX    77066

                               

                                   RMA  #  ___________________