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Estimate Number:	Optional
Company:	If business related or shipping from/to a business, provide your company's name.
Full name:	Required
Contact details:
Phone numbers: Daytime - - ext. Cell Fax	Example: 800-123-4567 Cell & Fax are Optional
Return Address:	Example: name or company 1000 broadway St. Boulder, CO 80302
Billing Address and Details:	Example: (required)Full Billing Name (optional)Business Name 1000 broadway St. Boulder, CO 80302
Payment method: Google Checkout Credit Card PayPal COD* Check Money Order Purchase Order	Please indicate how you wish to pay for repair. *CODs are only accepted from businesses.
Repair Process: Standard Repair 2 Day Expedite +$90.00* 5 Day Expedite +$45.00*	Selected standard or expedited repair process. Note: this for projectors only.
Email	Email is required for quotes and will not be used for any other purpose.
Please confirm	Required
Item(s) you are sending in for repair:	Please include: Brand name and Model Please repeat for each item
Description of problems:	Please note which item and under what conditions the problem occurs, if intermittent, any known causes, and any previously attempted repairs.
Start repairs if less than estimate or $:	Optional **We will contact you if repairs appear to exceed our estimate or this number, by providing this number it allows us to start repairs immediately after evaluating the actual projector and avoids any further delays.
Preferred contact method: Email Phone Cell Phone Fax!
Please press and confirm the information provided, then select the "submit" button on the next page.