Arizona Wireless & Radio, Inc.
2001 N. Third Street
Flagstaff, Arizona 86004
Phone: (928) 526-6000
Fax: (928) 774-5584

Equipment Repair Form

To receive a price quotation, please complete the following form for each radio needing repair, print and submit

Date (00/00/00):         Repair Case #:
Name*
Organization:
1
Phone* Email*
Address:
City*

State, Zip
1
Comments & Suggestions
1
 
Radio Manufacturer:
Model #:
Radio Serial #:
Frequency Band (check only one)  
High VHF:       Low VHF:       UHF:       800 MHZ:       Dual Band:
Purchase Date (00/00/00):       Warranty (check one):      In-Warranty       Out-Of-Warranty:
Check items included with this shipment:       Antenna:       Belt Clip:       Charger:
Speaker Mic:       Other:
Description of Problem:
 
Type of Payment (check only one)
      Personal Ck.:       Business Ck.:       Visa:       Mastercard:       Money Order:
Note: Please provide a list of your frequencies with your equipment if possible.
Validation*  
1
* - Required Fields