BuiltWithNOF

Repair Form

PRINT OUT FORM FOR EACH UNIT-FILL OUT AS COMPLETE AS POSSIBLE & MAIL

           Portable Radio Service, LLC

           209 Kera Drive, Mountain View, AR 72560

 

Customer Information:

Name _______________________________________________________

Address_____________________________________________________

City ________________________ State ___________ Zipcode _________

Phone  (_______)______________ FAX  (_______) __________________

Contact Person _______________________________________________

 Billing Information:         Credit Card

CC Number ___________________________________ Expires _________

Billing Address for Credit card if different from above:

Address_____________________________________________________

City ________________________ State ___________ Zipcode _________

Unit Information:

       Model # _____________________ Serial # ______________________

Frequency:                   Channel 1 TX _____________ RX ______________

                                     Channel 2 TX _____________ RX ______________

System Information:

       Control Channel ________ System ID _________  Fleet ID __________

 Problem/Symptom:   (Circle all that apply)

 Constant Tone               No Power                         No TX Modulation

   Poor RX                         No RX                            Physical Damage

  Intermittent                   Low Power                     Distorted TX Modulation

Distorted RX Audio       No RX Audio                 Liquid/Chemical Damage

Other ____________________________________________________

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