Crown Macro-Tech MA-5000VZ Reference Manual page 43

Crown Factory Service Information
Shipping Address: Crown Factory Service, 1718 W. Mishawaka Rd., Elkhart, IN 46517
Phone: 1-800-342-6939 or 1-574-294-8200 Fax: 1-574-294-8301
Owner's Name: _________________________________________________________________________
Shipping Address: ______________________________________________________________________
Phone Number: ______________________________
Model: _________________________ Serial Number: ______________ Purchase Date: ____________
(Be sure to describe the conditions that existed when the problem occurred and what attempts were made to correct it.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Other equipment in your system: __________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
If warranty has expired, payment will be:
Card Number:___________________________
Signature:____________________________
ENCLOSE THIS PORTION WITH THE UNIT. DO NOT MAIL SEPARATELY.
Fax Number: _____________________________
NATURE OF PROBLEM
Cash/Check
Exp. Date:_______
VISA MasterCard C.O.D.