Audio Video Service Labs

Address Name:
Street Address:
City:
State:
Zip:
Preferred Phone:
Alternate Phone:
Email:

Unit Model Number:
Serial Number

Samsung customers only

This information is usually found on either the back of the unit, or on a sticker on the side of the unit.

Model Code:
Version Code:
Lamp Code (Projection TVs):

Complaint:

Warranty Repair
Non-Warranty Repair

Non Warranty customers must place on file the credit card that will be used to pay for their repair. The card will not be charged until the repair is completed or the estimate is declined. If a repair is performed you will be charged the repair bill plus a trip charge based on your zip code. The trip charge for the zip code you input is displayed below. If the technician provides an estimate that you decline you will be charged a $40 minimum diagnostic fee plus the trip charge. There is some possibility that your complaint is one which will allow us to quote an estimate over the telephone with no initial technician visit. Should you decline a telephone estimate you will be only be charged the $40 minimum diagnostic fee.

Billing Address Name:
Billing Address:
City:
State:
Zip:

Card Info Card type
Card number
Expiration
CVV2/CVC2/CID Code

Purchase Date:
Store Purchased From:

I understand that the manufacturer requires a purchase receipt for any warranty repair. I will provide a photocopy of my purchase receipt to the service technician on his initial visit. I understand that the copy will not be returned. (A valid purchase receipt will include the item purchased, the purchase price, and the date of purchase. If you do not have a purchase receipt please call the manufacturer�s Customer Service number provided in your Owners Manual.)

Television Service