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)

$15.95
Return shipping for Ericofons (USA only)

$12.95
Total amount  

Payment method:
Check/Money Order ___  Visa ___ M/C ___ Discover ___ Amex ___   

Card # _________-_________-_________-_________

Exp. Date _____/_____                            CCV# ___________

Name (as shown on card)_________________________________
Comments: