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:



City, State____________________________________________

Zip Code_____________________________________________

Phone #______________________________________________


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


Return shipping for Ericofons (USA only)


Total amount  

Payment method:
Check/Money Order ___  Venmo ___ Paypal ___ CC ___

Card # _________-_________-_________-_________

Exp. Date _____/_____                            CCV# ___________

Name (as shown on card)_________________________________