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CT Power Amplifiers
SRA #: __________________(If sending product to Crown factory service.)
Individual or Business Name: ____________________________________________________________________________________________________________________________________________________________
Phone #: __________________________________________________
Street Address (please, no P.O. Boxes): _____________________________________________________________________________________________________________________________________________________
City: __________________________________________
Nature of problem: ___________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________
Other equipment in your system: _________________________________________________________________________________________________________________________________________________________
If warranty is expired, please provide method of payment. Proof of purchase may be required to validate warranty.
I have open account payment terms. Purchase order required. PO#: __________________________________
Credit Card (Information below is required; however if you do not want to provide this information at this time, we will contact you when your unit is repaired for the information.)
Credit card information:
Type of credit card:
MasterCard
Type of credit card account:
Personal/Consumer
Card # ______________________________________________ Exp. date: _____________ * Card ID #: __________________________
* Card ID # is located on the back of the card following the credit card #, in the signature area. On American Express, it may be located on the front of the card. This number is required to process the charge to your account. If you do not want to provide
it at this time, we will call you to obtain this number when the repair of your unit is complete.
Name on credit card:
____________________________________________________________________________
Billing address of credit card: __________________________________________________________________________
__________________________________________________________________________
Operation Manual
__________________________________________________________________________
Crown Audio Factory Service Information
Shipping Address: Crown Audio Factory Service, 1718 W. Mishawaka Rd., Elkhart, IN 46517
PLEASE PRINT CLEARLY
Model: ____________________________________________
PRODUCT RETURN INFORMATION
Fax #: ________________________________________
State/Prov: ________________________________
PAYMENT OPTIONS
Visa
American Express
Business/Corporate
Serial Number: _____________________
E-Mail: _______________________________________________________
Postal Code: _________________
COD
Discover
Purchase Date: _____________
Country: _________________________
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