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…..
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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