Name: Address: Address: (Note: No PO Boxes, please) City: State: Zip Code: Phone number: Email Address: Appliance Brand & Type: (e.g., Norelco Shaver, Farberware Percolator, etc.) Model Number: Please describe the problem with the appliance: Stated charge for the repair: __ $29.99 __ $39.99 __ $49.99 __ $59.99 Other (please state): $____ Method of payment for the repair: __ Visa __ MasterCard __ Check ⁄ Money Order Is payment included with the item? __ Yes __ No Ship to: Buyitnow Yahoo Repairs 303 W. 79th St. Kansas City, MO 64114 |
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