Print this form to send in with unit to :

BC Electronics 2346 BRISTOL-OXFORD VALLEY RD LEVITTOWN, PA 19057-1305

Phone:   215-547-7600

Please complete and print clearly to help speed up your record player repair.

Name___________________________________________________
Address_________________________________________________
City______________________________State______Zip__________

Remember that FEDEX requires packages to go to a physical address (not PO Box) and
someone should be there to receive it.  (We currently ship by FEDEX only)

Return shipping address if different than above:_____________________________________________________________________

EMAIL ADDRESS : ___________________________________
Home Phone (____)____________________
Work Phone  (____)____________________
Cell Phone or Pager (____)__________________

Please provide make & model if known: _________________________________________________________

Problem with unit_____________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

You are responsible for the packaging when shipping to us.
You can insure your equipment for just a few dollars, but the best insurance is to be sure it is packaged correctly.
Insurance won't pay if not correctly packaged.   PACKAGING GUIDELINES

THIS IS YOUR AGREEMENT FOR THE MINIMUM LABOR / DIAGNOSTIC CHARGE AND PAYMENT. I am aware there is a non-refundable minimum labor charge of $63.50 for a diagnosis / estimate on each record player that I send in for repair. This Fee does not include return shipping. Return shipping charge will be based upon current FEDEX pricing. Please circle one:    ESTIMATE FIRST      or      OK TO REPAIR UP TO $_________ Signed _______________________ Print Name as on card: _____________________ Billing Address & Zipcode ( if different than above )______________________________________ Circle Credit Card Type:    MasterCard    -    Visa    -   Discover    -    Amex Card # __________________________ Exp ________ Security Code*_________ * The Security Code is 3 digit number after last 4 numbers on the signature area on back of Visa, MasterCard, or Discover. Amex prints 4 digits on the front of the card above and to the right of the account number. Enclosed is my check / money order for $________ (personal checks - allow 14 days to clear)