Arizona Wireless & Radio, Inc.
2320 East Fifth Avenue, Suite C
Flagstaff, Arizona 86004
(928) 526-6000
RADIO EQUIPMENT REPAIR FORM
Date (00/00/00):
Repair Case #:
Last Name:
First Name:
Organization:
Ship To -
Mailing Address:
City:
State:
Zip Code:
Daytime Phone # -
Area Code:
Phone:
Email:
Radio Manufacturer:
Model #:
Radio Serial #:
Frequency Band (check only one)
High VHF:
Low VHF:
UHF:
800 MHZ:
Dual Band
Purchase Date (00/00/00):
(check one)
Warranty:
Out-Of-Warranty:
Check items included with this shipment -
Antenna:
Belt Clip:
Charger:
Speaker Mic:
Other:
Description of Problem:
Type of Payment (check only one)Personal Ck.:
Business Ck.:
Visa:
Mastercard:
Money Order:
Note: Please provide a list of your frequencies with your equipment if possible.
first Print - then Submit