ATUS Service Form
PleASe Fill oUT Form comPleTely And reTUrn wiTh yoUr rePAir.
reTUrn ShiPPinG nAme And AddreSS:
*Please Note: ATUS will not ship product to P.O. Boxes*
ATUS dealer Acc # and ref # (if applicable):________________________________________
______________________________________________________________________________
Return Shipping Name:_______________________________________________________
Street Address:______________________________________________________________
City: _______________________ State: _______________ Zip Code:__________________
Contact Person:______________________________________________________________
Telephone (daytime): (____)______________Other Telephone: (____)_______________
Fax: (____)______________E-Mail:_______________________________________________
Special Return Shipping Instructions:__________________________________________
______________________________________________________________________________
ProdUcT inFormATion:
Product Model Number / Serial Number (if applicable):
______________________________________________________________________________
Is the Product under warranty? o No o Yes
iF yeS, Provide A SAleS SliP or oTher ProoF oF PUrchASe dATe To vAlidATe wArrAnTy.
All rePAirS wiThoUT ProoF oF PUrchASe Are conSidered oUT-oF-wArrAnTy And will be chArGed.
Please provide a detailed description of the problem and any special instructions:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
US Postal ZIP Codes where wireless products are used (if applicable):_______________
crediT cArd PAymenT inFormATion (non-wArrAnTy rePAir only):
Method of Payment: o Visa o MasterCard o Discover o Dealer Account
o American Express o C.O.D.
Card Number:________________________________________________________________
Expiration Date:___________________________ Security Code:_____________________
Name As It Appears On Card:_________________________________________________
Credit Card Billing Address (if different from above):_________________________________
______________________________________________________________________________
Audio-Technica U.S., inc., 1221 Commerce Drive, Stow, Ohio 44224
Form No. 0000-6220-00