ON BUDGET RADIO REPAIR FORM
11 Ledgehill Rd.
Weymouth, MA 02188
617-934-0310
Your Contact Information
Company:
Name: Title:
Address:
City:
State: Zip:
Contact Number:
Email Address:
Radio Information
(Please complete one form for each radio to be repaired)
Make: Model:
Serial#:
Accessories Included: (Please check all that apply)
•Charger •Battery •Antenna •Belt-Clip
•Speaker Mic •Headset
•Other (Explain):
WHAT’S WRONG WITH YOUR RADIO?
(Please check all that apply)
•No Transmit •No Receive •Poor Receive/Static
•Poor Transmit/Short Range •Operation Dead
•Case/Antenna Jack Broken •Analyze Battery
•Other (Explain):
•Please Contact Me With An Estimate
Special Instructions: