| Classic Car Radio Repair |
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| Classic Customer Care Form |
Customer Name ________________________________________________________
Address for return _______________________________________________________
City, State, Zip __________________________________________________________
E-mail _________________________________________________________________
Phone ________________________________________________________
Unit model (if known) ____________________________________________
Serial # (if known) _______________________________________________
Car Year - Make - Model _________________________________________
Included (knobs, etc.) ____________________________________________
Amount prepaid _________________________________________________
Date sent ______________________________________________________
Description of failure(s) ___________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Additional services desired ________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Address for return _______________________________________________________
City, State, Zip __________________________________________________________
E-mail _________________________________________________________________
Phone ________________________________________________________
Unit model (if known) ____________________________________________
Serial # (if known) _______________________________________________
Car Year - Make - Model _________________________________________
Included (knobs, etc.) ____________________________________________
Amount prepaid _________________________________________________
Date sent ______________________________________________________
Description of failure(s) ___________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Additional services desired ________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________