CompassCom Software Corp

Repair

Registration

Please provide the Following Information.
* indicates required fields Contact Details: Note: If you plan on using a Credit Card for payment after the repair is complete, this should be your Credit Card Billing Address. If you wish, you can provide an alternate shipping address in the Payment Details section below.
First Name*
Last Name*
Company
Address 1*
Address 2
City*
State/Province*
Postal Code*
Country*
Phone*
Cell Number
Email*

Equipment Details:
Equipment Type*
Serial Number
Part Number


Describe Failures:
Hardware Damage

Software Failure

Do You Require an Estimate Prior to Repair?*
NOTE: MINIMUM $30.00 CHARGE PER UNIT FOR ESTIMATE. Unless under warranty.

Payment Details:
Method of Payment*

Shipping Method*	(Expedite will incur $50.00 charge)

Return Shipping Address (If different from Billing Address provided above)

Please provide tax-exempt certificate, otherwise tax will be added.

Do you want an invoice sent with repaired equipment?*


Additional Questions or Comments