Repair order form US

Invoice Address
Company Name*
Department
Customer no.
P.O Box/Street*
Postal Code*
City*
Country*

Shipping Address
Company Name*
Department
Customer no.
P.O Box/Street*
Postal Code*
City*
Country*

- Use Invoice address as Shipping address

Order Reference*

Contact person*
Email*

Telephone*
Fax

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

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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