High Energy Repair Order Form 1-727-797-6440
Please fill in the blanks as needed, print form and enclose form inside box with item.
 
   
Company:
First Name:
Last Name:
Physical Address:
City:
State:
ZIP:
   
Bus. Phone:
Home Phone:
Work Phone:
Cell Phone:
Email
  
Unit Make:
Model/Chassis:
Serial Number:
Type of Unit:

Problem with unit or Reason for Repair:

( You may enter up to 160 characters. )

characters left
Is the item under warranty?
Yes
No
I am paying for repair.
If Yes, Please enclose the sales receipt.
 
Print page
Print
 
 

Please package the unit carefully. If available, use the original box and packing materials. If you no longer have the original box, wrap the unit in plenty of bubblewrap and add peanuts to make sure the unit does not shift during transit.

Note: Shipping Insurance does not cover damage to improperly packed items.

Ship the unit prepaid and insured to us at the address listed below.

Our Non-Warranty Labor rate is $75.00 per hour plus parts. All units will be automatically repaired if the cost does not exceed $150.00 An estimate will be provided if the cost to repair will exceed $150.00. Any declined estimate will be subject to a $50.00 Diagnostic Fee that is required up-front.

The $50.00 up-front fee may be paid with Check, Money Order, Visa or Mastercard.
 

Ship To:

High Energy Repair
21929 US 19 N.
Clearwater, FL 33765