SERVICE ORDER FORM

SIMPLY COPY AND PASTE THIS FORM INTO A WORD PROGRAM & PRINT IT OUT AND INCLUDE IT WITH YOUR RADIO….

TODAYS DATE _______________________

Please Fill in Exact Shipping Address !!

NAME:____________________________________________

STREET ADDRESS___________________________________

PO BOX if applicable: ________________________________

CITY: ____________________________________________

STATE:______

ZIP:      _______________

CELLPHONE     (    ) ___  _______

EMAIL ADDRESS:_____________________required for Billing

PLEASE DESCRIBE IN DETAIL OF ALL PROBLEMS YOUR HAVING WITH YOUR RADIO…..

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

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Please initial the following statement,  Thank You !

(    ) Radio came from an airworthy aircraft functional and it just recently failed.

SIGNATURE:_____________________________________ ( Owner)

KX170B or 175b serial must be above 20000

We ACCEPT all serial numbers for  KX155  KX165 


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