form - service request - Simeon Canada | Supportive Hearing Systems Inc.

Customer Information

Requester Name *

Email Address *

Phone Number *

Student Name

School Board

School / Customer Name

Ship Back Address *

City *

Province *

Postal Code *

Attention To *

Repair Information

Original Invoice / Packing Slip Number

System Serial Numbers

Covered Under Warranty or Service Plus? *

If not covered, what service level is preferred? *

Above service levels apply to standard soundfield configurations only. Customer will be contacted with a repair quote for personal fm systems (base charge of $25 still applies). Customer will be contacted with a repair quote if required repairs exceed service level designation or replacements are required.

What units have been sent in? *

Please describe the issue with the unit and any troubleshooting performed (be specific) *

Additional Comments / Special Instructions

Charge for declined repairs *

I understand that if this is not covered under warranty and repair is declined there will be a base charge of $25 for shipping.

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