Service & Repair Order Form

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Ship prepaid and insured to:
MAC Group, 75 Virginia Road, North White Plains, NY 10603
Phone: 914-347-3300 Fax: 800-321-2205

YES! I hereby pre-approve a repair estimate of $_______. If the charge is higher, contact me before proceeding.

Ship U.P.S. to the address below via:
Ground @ $20, 3rd day air @ $35, 2nd day air @ $40, Next day air @ $50.

I hereby request expedited service at an extra charge of $30 (telephone in advance to make these arrangements).

Name
Company
Address
City / State / Zip
Telephone / Fax
Method of Payment: Check Amex Visa MasterCard
Account No.
Expiration Date
Name on Card
Signature / Date


Please include a letter with a thorough explanation of the problem or service to be performed. List each item, with serial numbers included in this shipment.

Service & Repair


All information and offers contained herewith apply to the USA only.
© 2012 Mamiya America Corporation