Crown Audio PIP-USP4 Module - Manual (Page 15)

Networked PIP Series
Reference Manual page 15
Crown Factory Service Information
Shipping Address: Crown Factory Service, 1718 W. Mishawaka Rd., Elkhart, IN 46517
PLEASE PRINT CLEARLY
SRA #: __________________(If sending product to Crown factory service.) Model: ______________
Serial Number: _____________________ Purchase Date: ____________
PRODUCT RETURN INFORMATION
Individual or Business Name: _____________________________________________________________________
Phone #: _____________________________________ Fax #: __________________________________
E-Mail: _______________________________________
Street Address (please, no P.O. Boxes): ____________________________________________________________
____________________________________________________________________________________________
City: _________________________________________________ State/Prov: ____________________
Postal Code: _________________ Country: _________________________
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.
PAYMENT OPTIONS
I have open account payment terms. Purchase order required. PO#: ______________________ COD
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 Visa American Express Discover
Type of credit card account: Personal/Consumer Business/Corporate
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: __________________________________________
__________________________________________
__________________________________________
__________________________________________