Repair Service Customer Information Sheet

**Please fill, print and send this completed form with your part**

Mailing Address:

German Audio Tech
Attn: Repair Dept.
65 Pine Ave. #337
Long Beach, CA 90802

Hello, my information is as follows:

Name:

Address:

Email

Telephone Number:

Service Purchase Date:

eBay Information (If Applicable)

eBay User ID:

Symptoms are as follows:

Special Notes:

THANK YOU!