MONITOR DEPOT, INC         

5359 West Richey Road  Houston,  Texas  77066                  CALL:  (281) 580 - 5656

FLAT PANEL MONITOR REPAIR FORM

STEP 1:  Ship to      Check:   Residential   OR   Commercial  Address

Company Name:   ___________________________________________  

Attn  _______________________________________________________

Street:______________________________________________________

City: ________________________, St __________ Zip_______________

Tel:  ( ____ )    ______    -    _______  

E-mail:__________________________________________________ (Please print clearly)

RMA # ISSUED:    ________________          Send any outside power supply

Unit 1  Brand & Model # ______________________________________________

Serial Numbers:             ______________________________________________

Problem Description:      ____________________________________________

Unit 2  Brand & Model # ______________________________________________

Serial Numbers:              ______________________________________________

Problem Description:      ____________________________________________

UPS Insurance value wanted  for return shipping  ( if any)   $   _____________

(Not included in free shipping offer, first $100 is no charge)