Cell Phone Repair of Long Island

Customer Data Sheet
Please print, fill out and send in with your device

Name_________________________________
Address_______________________________
City__________________________________
State__________________________________
Zip___________________________________
Contact Number________________________
Alternate Number_______________________
Email Address__________________________


Device Make and Model______________________________________
Device Imei or ESN (serial number)_____________________________

Explain problem(s) with device_________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________










	Send only your phone and battery. Do not send your charger, battery door, SIM card, or memory card. We are not responsible for any additional items.

	Carefully package your phone in small box or padded envelope. Request delivery confirmation or tracking number. You may want to insure package for your safety.              

	We will contact you within 24 hours of receiving your phone to provide you with an estimate. Upon your approval and receiving payment, we will repair your phone and ship it back to you immediately. If you decide not to repair your phone then a $15 shipping fee will be charged to ship your phone back to you.

We accept all major credit cards.

___________________________     ___________
Customer Signature                           Date	

CPR of Long Island wants to Thank You for your business and welcomes you to call with any questions (631) 586-9584