Telephone Service Order

To send in your phone for repair, fill out this form, print it, and send it in with your phone.

Send the phone to:

Richard Rose
2636 Suzanne Circle
White Bear Twp, MN  55110

 

 

Your Information:

Name:_______________________________________________

Address:____________________________________________

City, State____________________________________________

Zip Code_____________________________________________

Phone #______________________________________________

E-mail________________________________________________

Work to be done: Price
   
   
   
   
   
   
   
   
Return shipping for all phones other than Ericofon (USA only)

$17.95

Return shipping for Ericofons (USA only)

$13.95

Total amount  

Payment method:
Payment can be by check, money order, or Venmo. I can also set up an online invoice for you. If you wish to pay by personal check or money order, go ahead and include it with this form.

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