Retailer Repair Form

Please ensure you have read the repair information and retailer information pages before completing this form.

 

Reference Number:    

Retailer Information:

Retailer Name:  

Retailer Reference Number:  

Return Address:

Retailer Phone:   

Retailer Email:   

Customer Information:

Customer Name:

Customer Address:

Customer Phone:

Customer Email: 

Equipment Details:

Make: Model: Serial number:
Make: Model: Serial number:
Make: Model: Serial number:

Accessories:  

(i.e. Battery, strap, memory card, etc.)

Type Of Repair:

Non-Warranty Repair *Inspection Fee Required For Non-Account Holders

Warranty Repair *Proof of Purchase Upload *Must be less than 250kb*:

Description of faults / work required :

 

 

By submitting this form you acknowledge you have read and agree to Phototronic Services repair terms and conditions as outlined on the repair information and retailer information pages. If you have any concerns regarding sending your credit card details on this form and/or receiving a copy by email we recommend paying the inspection fee by direct bank instead.

 

Please Note there is no need to print this page.

A printer friendly copy will be sent to your nominated email address. If you do not receive this email please check your spam folder or contact us for a copy.