Repair order form US, Canada, Mexico

Your Order Reference*
Contact person*
Email*
Telephone*

Please include this completed form and ship repairs to:

Eltex U.S., Inc.
13031 E. Wade Hampton Blvd
Greer, South Carolina 29651, USA

- Use Invoice address as Return Shipping address

Ordering Company - Invoice Address
Company Name*
Department
Your Customer no.
P.O Box/Street*
Zip Code*
City*
Country*
Invoice Email Address*

Return Shipping Address
Company Name
Department
Your Customer no.
P.O Box/Street
Zip Code
City
Country

Items for repair
List
Qty Part number + serial number Fault description
Notes (free text to add)...
Copy of order is automatically generated to the e-mail address above
reCAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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