Equipment Repair Form

Submit this form with equipment to APS only. Do not send this form separately.

Date

Return Shipping Address

Name

Company

Street Address (No P.O. Box)

City / State / ZIP

Phone

Alternate Phone

Warranty / Coverage

Nikon Warranty (attach copy of sales receipt) APS Repair Warranty Serviced by APS within the last 180 days

Equipment & Problem(s)

Model No.	Serial No. (if available)	Problem / Reason for Service

Payment: Repair work, parts, and service charges will be determined after we review your equipment. We provide a free estimate for your approval before any work begins. Please do not send payment or card information with this form.

Signature

Date