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Radio Repair Form

Radio Research Inc.
220 Finley Ave, Staten Island, NY 10306
Phone: +1 718-980-6787, sales@radioresearch.us


Please make copy and attach one form per radio

Radio serial number

Radio model number

Accessories included with radio: (check all that apply)

Please include accessories if they are only connected with problem of the radio.

Battery

Belt Clip

Headset

Carrying Case

Antenna

Charger

Microphone

Other_______

Description of radio problem: (check all that apply)

No Transmit

No Receive

Dead

Liquid Damage

Poor Transmit

Poor Receive

Physical Damage

Other________

Accessories need to be added with radio after repair: (check all that apply)

Battery

Belt Clip

Headset

Carrying Case

Antenna

Charger

Microphone

Other ______

Party responsible for radio equipment:

Company:

Contact name:

eMail address:

Phone #

Fax # :

Address:

Payment information:  Check/MO Bill my PayPal account __________________________________

Visa/MasterCard_____________________________________ Exp. Date_______

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