REMOTE REPAIR ORDER FORM


Name___________________________________________________


Address________________________________________________


City___________________________________________________


Postcode_______________________________________________


Email__________________________________________________


Phone__________________________________________________


Payment Method by Cheque P.O. made payable to AnyRemote


Paypal? Payment Date Please_____________


Visa Mastercard American-Express Maestro


Card Number__________ ___________ ___________ _________


Expiry Date______________ Valid From______________


Issue Number_____________


Security Code____________


Repair Information




REMOTE BRAND______________REMOTE NUMBER________________




MODEL NUMBER______________




PROBLEM WITH REMOTE


___________________________________________________________________________________






___________________________________________________________________________________






SPECIAL INSTRUCTIONS




__________________________________________________________________________________






___________________________________________________________________________________






Standard Remotes £12.50 [ ] Special Remotes £18.00 [ ]

In the unlikely event that a repair is not possible a small handling charge of £2.50 will be made to cover return postage. This will be refunded in full if you purchase a new remote from us.


Special Remotes consist of multiple circuit boards or slides. Not sure then send £18.00 and we will refund the difference. Price includes return post and packing. For your own protection and piece of mind we recommend either sending by recorded delivery or obtaining a certificate of posting.




TOTAL AMOUNT £___________ ENCLOSED




Post completed form and Remote to:

Remote Repair Service

Field View House

Green Lane

Hemingby

Lincolnshire

LN9 5QH

or


CALL 01507 578773