Repair order form Europe and other non-US countries

Your Order Reference*
Contact person*
Email*
Telephone*

Please include this completed form and ship repairs to:

Eltex Manufacturing Ltd.
Railway Road
Templemore, Co. Tipperary
E41 HX65, Ireland.

- Use Invoice address as Return Shipping address

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

Return Shipping Address
Company Name
Org. nr (VAT)
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.

To locate a reseller in your country, click here