Factory Repair Appointment Request

CONTACT INFORMATION

Please enter your contact infromation to arrange a Factory Repair Appointment

* Full Name:
* Email:
* Phone:
Address 1:
Address 2:
Town / City:
Province:
Postal Code:

Please select your prefered day of the week and time of day for your Factory Repair Appointment (for no preference, leave blank)

Monday:
Tuesday:
Wednesday:
Thursday:
Friday:

Please describe the nature of your Factory Repair

* Description:

Please enter the model details for your Factory Repair Appointment

* Model:
* Serial Number:
* Warranty Status:
* Date of Purchase:

Included Accessories:

Model:
Serial Number:
Warranty Status:
Date of Purchase:

Included Accessories:

Model:
Serial Number:
Warranty Status:
Date of Purchase:

Included Accessories: