Repair order form US, Canada, Mexico

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    Invoice address as Shipping address

  • Contact person

  • Contact info

  • Please include this completed form and ship repairs to:

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

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    Invoice address

  • Ordering Company - Invoice Address

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    Shipping address

  • Return Shipping Address

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    Items

  • Items for repair

  • QtyPart number + serial numberFault description 

  • Copy of order is automatically generated to the e-mail address above