Service Request Form
Please fill out this form completly or print and fill out a printable fax version so that we can give you an RMA number to send in with your unit.
* = Required Fields
C O N T A C T I N F O R M A T I O N
*First Name:
*Last:
CustID:
*Organization
*Phone:
Fax: *Email:
*Shipping Address:
*City:
State:
- - AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Other *Zip: *Country: USA Afghanistan Andorra Anguilla Antigua Antilles(Netherlands) Argentina Armenia Aruba Australia Austria Bahamas Bahrain Bangladesh Barbados Belgium Belize Bermuda Boliva Brazil Cambodia Canada Cape Verde Islands Cayman Islands Chile China Colombia Colombia Cote d'Ivoire(Ivory Coast) Croatia Cuba Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Faeroe Islands Fiji Finland France Gabon Gambia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Inmarsat Ireland Israel Italy Jamaica Japan Jordan Kenya Korea(North) Korea(South) Kuwait Lebanon Liberia Liechtenstein Luxembourg Macao Malawi Malaysia Malta Mauritius Mexico Monaco Montserrat Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Romania Russian Federation Samoa Saudi Arabia Singapore Slovakia Republic South Africa Spain Sri Lanka Surinam Sweden Switzerland Syria Taiwan Thailand Turkey United Arab Emirates United Kingdom United States Uruguay Venezuela Virgin Islands Yugoslavia Zambia Zimbabwe
Use same address for shipping and invoicing
Invoicing Address:
City:
- - AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Other Zip: Country: USA Afghanistan Andorra Anguilla Antigua Antilles(Netherlands) Argentina Armenia Aruba Australia Austria Bahamas Bahrain Bangladesh Barbados Belgium Belize Bermuda Boliva Brazil Cambodia Canada Cape Verde Islands Cayman Islands Chile China Colombia Colombia Cote d'Ivoire(Ivory Coast) Croatia Cuba Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Faeroe Islands Fiji Finland France Gabon Gambia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Inmarsat Ireland Israel Italy Jamaica Japan Jordan Kenya Korea(North) Korea(South) Kuwait Lebanon Liberia Liechtenstein Luxembourg Macao Malawi Malaysia Malta Mauritius Mexico Monaco Montserrat Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Paraguay Peru Philippines Poland Portugal Puerto Rico Romania Russian Federation Samoa Saudi Arabia Singapore Slovakia Republic South Africa Spain Sri Lanka Surinam Sweden Switzerland Syria Taiwan Thailand Turkey United Arab Emirates United Kingdom United States Uruguay Venezuela Virgin Islands Yugoslavia Zambia Zimbabwe
P R O D U C T I N F O R M A T I O N
*Unit Model:
*Serial Number:
*Problem:
Unit Model:
Serial Number:
Problem:
*Amount Authorized for Repair: .00
Purchase Order #(if applicable):
Credit Card: - - Visa MasterCard Expiration:
Name as it appears on Card:
CMT will contact you within 24 hours to give you pricing information and a RMA number that you can attach to your units and then ship to us.
Note: All shipping charges, duties, and taxes for the RMA are the customer's responibility.
Caution: Make sure you completly fill out the form before you proceed, or you might have to start over!
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