Non Warranty Form

General Repair Form REV 3-201 4

Centreville Electronics

9437 Main St.

Manassas, VA 20110

PH 703-367-7999 Fax 703-367-0868

E-Mail bobnpaul@centrevilleelectronics.net

Purchase Date and Dealer Information is NOT NEEDED for NON-WARRANTY REPAIRS

Name____________________________________________

Address__________________________________________

City_______________ State__________ Zip_____________

E-Mail (print in caps)_________________________________

Phone: ______________________________________

Problems with Unit

The minimum labor charge will be $70.00 plus parts and shipping.

The repair may be paid for using Visa, MasterCard, or PayPal. Or by sending us a check. .

Ship the Unit, Coil, Battery used with failed unit. We do not need the rods unless unit is a Factory hip mount.

Please print out the form, fill it out and send it with your unit. We will contact you within a week with the estimate.