JB Monitor Repair
Repair Tag
Conpany Name ___________________________________________
Contact Person ___________________________________________
Email Address ____________________________________________
Pay by : PayPal____ Visa____ Master Card____ Amex____Cash____
Phone __________________________________________________
Shipping Address Street____________________________________
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City, State, Zip____________________________________________
Monitor Make/Model (for example: Wells Gardner D279400)
________________________________________________________
Detailed description of the problem ____________________________
________________________________________________________
________________________________________________________
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