eProvided.com Repair Form - Fill Out All Info to Receive Faster Service! - Tuesday, February 07, 2012
See Common Questions: Repair Questions Turn-around 5-7 Days or Less.
Don't call for status/shipping updates; we'll call you if needed. Use FedEx tracking to determine arrival.
Client Information Repair Pricing Information
Name: _______________ ___________________ No repair means No $20.00 charge*
Address 1: ________________________________ Repair fee of $20.00 will be charged/kept if device is repaired.
Address 2: ________________________________ A $20.00 fee is charged for Shipping/Analysis on each order
City: _____________________________________ (Include $40.00 when shipping, cash if possible or make check out to
State: _____ Zip: _________ Country: __________ eProvided.com)
Company : ________________________________ If requesting to pay by credit card please fill in ALL credit card info below
Phone (Cell is best) _________________________ *Applies to all mailed in media devices
*E-Mail: __________________________________ To pay with Paypal send $40.00 exactly to Contact@eprovided.com once
*Please Print Clearly | Use PayPal e-mail if possible logged in & click on the “Send Money” tab. Be sure to put the name you use
on this form on the “Message to Recipient” section of the Paypal payment
pages.
File/Media Information
Credit Card Info. For Credit Card Payment Requests
Media Type (Check): Country
First Name
□ USB □ Other __________________________ Last Name
CardType (MC, Amex, Visa
Media Size/Capacity: _________ MB or GB (circle one) …)
Make & Model (if available): _____________________
Card Number
Expiration Date (MM/YY)
Security Code (Locate last 3
digits, AMEX = 4 Digit Code on Face
of Card)
Address Line 1
Shipping to eProvided: Mail this Form & Media to: Address Line 2
City
eProvided State
Attn: Device Repairs Zipcode
5485 Spur Cross Trail E-mail Address
Parker, CO 80134 Phone: (Cell phone is best)
Describe the problem, what happened to this device (use back of form or separate sheet if necessary):
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
How did you find us? (Check)
□ Friend/Associate □ Camera/Retail Store (store name): _____________________ □ News Article/Story - _______________________
□ Trade Magazine - PC Photo - TIME □ Search Engine: Google | Yahoo | MSN | Ask Jeeves | All The Web | AltaVista | AOL
□ Other: ________ □ Sponsored Search Result Listing (PPC): ___________
*eProvided is not responsible for media mailed improperly. Protect shipments by wrapping it with bubble- wrap and/or using a padded box/envelope.
Repairs cannot be guaranteed in all situations, as devices may be damaged past a point of salvation. I understand I'm in no way guaranteed
device will be repaired regardless of any expressed or implied comments. Device will be reformatted to manufacturers specifications and all
data will be lost if drive is repaired. This is not data recovery service. I've read eProvided's "Policies, Terms Conditions" linked on the
eProvided homepage & agree to all terms & conditions. I understand there are repair as well as ship/hand/analysis fees. I've read this entire
form. I indemnify, defend, & hold harmless eProvided for any & all liability, demands, actions, liens, losses, damages, costs, judgments, &
expense, including reasonable attorney's fees arising out of or resulting from any eProvided services. I authorize eProvided to bill me for
services rendered if repairs are made. (We accept PayPal, USPS Money Orders ONLY, cash, checks & credit cards)
Print Name: ______________________________ Signature: ____________________________ Date: _____________