| Third Party Request for
Consumer Form |
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| *Required Fields |
| Company
Name* |
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Store #* |
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| Contact
Name* |
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Email Address* |
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| Return
Shipping Address* |
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City* |
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State* |
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Zip* |
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| Phone
#* |
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Ext. |
|
Fax Number* |
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| Thomson Service Billing
Account Number* |
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| |
| *Required Consumer Fields |
| First Name* |
|
Last Name* |
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| Address* |
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| City* |
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State/Prov* |
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Zip* |
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| Phone Number* |
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Date of Purchase* |
| 97 November 2008 8: | |
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| Email* |
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| Model Number* |
Serial Number* |
Complaint |
Claim/PO* |
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Remember:
:. The assigned service Request (SR) number must
appear on the outside of the correct unit's return shipping carton.
:. Ship the main unit only: No Accessories(access cards, remote, cables,
power cord, or manual).
:. Units received without a valid SR Number will be returned AS-IS
:. If you are shipping multiple units in the same carton, please enclose
a copy of this form.
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