Welcome to the Laureldale Service Center

For every radio you buy, we donate to two local foundations. HELP US REACH OUR GOALS

RADIO REPAIR REQUEST

Please complete one form for each radio that you are sending in for repair.

Please print copy of request and send copy along with radio.

Today's Date: *

Shipping Date: *

Company Name: *

Department:

Contact Name: *

Title: *

Shipping Address: *

Billing Address if different than shipping address:

Contact Phone Number: *

Fax Number:

Contact Email Address: *

Purchase Order Number: *

Make of Radio: *

Model of Radio: *

Serial Number:

Accessories Included: Please check all that apply: *

Please check all accessories that you will be shipping with radio.

Other:

Please list other accessories you may be sending:

Explain problem with radio:

Please give more detail of problem:

Request Estimate prior to repair:

Request Estimate

Special Instructions or comments:

Please ship your radio(s) to the attention of the Service Department -- 3201 Montrose Ave., Laureldale, PA 19605

Lancaster: 717.656.2211 | Harrisburg: 717.774.7455 | Reading: 610.929.4211

940 West Main Street, New Holland, PA 17557

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