Ambus Repair Form

Repair Form *ALL FIELDS ARE REQUIRED. PLEASE PRINT CLEARLY. ORGANIZATION:________________________________________ CONTACT:_____________________________________________ ADDRESS:____________________________________________ CITY:___________________STATE:_____ ZIP:_________ TELEPHONE:(_____) _______- ___________ FAX (_____) _______ - __________ E-MAIL:_______________________________________________ DESCRIPTION OF PROBLEM: _____________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ DATE PURCHASED (IF KNOWN):___________________________ PURCHASED FROM (CIRCLE ONE): (AMB) (DISTRIBUTOR) (CLUB) OTHER:______________________

PAYMENT INFORMATION ___CREDIT ___DEBIT CARD TYPE:_________________________ NUMBER:___________________________ EXPIRATION:_________________________ CW2(3 DIGIT CODE ON BACK):__________

PREAUTHORIZED AMOUNT: ___$150 ___$250 ___$500 ___$1000 SIGNATURE__________________________ DATE_______________________________ LIST AMB EQUIPMENT SENT FOR REPAIR:

TRANSPONDER(S)

DECODERS(S)

SHIPPING METHOD PREFERRED

QTY

QTY

U.S.A

___ AMBrc DP ___ AMBrc RECHARGEABLE ___ AMB MX ___ AMB MX TRACKSIDE OEM ___ TRANX160 ___ TRANX260 RECHARGEABLE ___ TRANX260 DP ___ TRANX Pro ___ AMB20 ___ ACTIV/ELITE ___OTHER

___ AMBrc ___AMB MX ___ACTIV

__GROUND __NEXT DAY AIR __2ND DAY AIR __ 3 DAY SELECT

NUMBER(S) REQUIRED:

___ TRANX-2 SINGLE LOOP ___ TRANX-2 EXTENDED LOOP ___ TRANX PRO ___ TRACK SIDE UNIT ___ TRANX3 DECODERS(S) SERIAL # REQUIRED:

INTERNATIONAL __WOLRDWIDE STANDARD __WOLRDWIDE EXPRESS **PRODUCTS UNDER WARRANTY RECEIVE FREE GROUND/ STANDARD SHIPPING. ANY OTHER SHIPPING METHOD CHECKED WILL BE CHARGED TO CREDIT CARD. **

PLEASE ALLOW 1-2 WEEKS TO PROCESS REPAIR(S) FROM DATE OF ARRIVAL. OFFICE USE ONLY: DATE ARRIVED:__________ WARRANTY: Yes No Website: www.amb-it.com

Repair Form 1. Repair Form: To insure an accurate repair of your equipment, AMB will thoroughly test your product to diagnose the fault. Please complete the repair form above and retain a copy for your records. The approximate testing and repair times for AMB equipment based on date of receipt is 2 weeks (excluding shipping and administration time), depending on nature of the problem of the equipment. 2. Diagnosis: Each repair will incur a diagnosis fee of € 40,00 for each non-transponder product. If your product requires an additional repair cost, this fee will be included in the repair costs. Diagnosis cost does not include shipping or VAT. 3. Transponders: In some cases, your transponder may be replaced with a refurbished AMB transponder to increase the speed of transponder repair. You may not receive the transponder(number) that was sent for service. 4. Warranty Repairs: To insure you the fastest delivery of your equipment, all equipment repaired under warranty incurring no cost will be shipped directly back to you. 5. Payment: AMB offers two forms of repair payment. Standard: If your transponder requires payment, you will be notified of the cost before the repair is completed. After receipt of payment, repair will be completed and shipped to you. Expedited: If your transponder requires payment, you can pre-indicate a maximum cost of repair that can be done. If your repair cost falls under the indicated amount, your provided credit card will be charged and your repair will be completed. You will receive an invoice with the delivery of your repair. To take advantage of this service, please complete credit card details below for one time use: 6. Shipping and Delivery. Please securely pack your repair in a box (decoder) or padded envelope and send to the address below. AMB is not responsible for loss or repairing damage that occurs during shipment. AMB offers return transport by courier or airmail post. Courier is more costly than airmail post. Only products under 500g can be shipped by post. Please note that damages or lost shipments per airmail are the addressee’s responsibility. Send repair(s) to: 3200 Highlands Parkway Suite 104 Smyrna, GA 30082 Phone: 678.816.4000 Fax: 678.816.4001 E-mail: [email protected]

Website: www.amb-it.com