Ready Welder II Repair Request Form
First Name:
Middle Initial:
Last Name:
Address:
Apartment Number:
City:
State:
--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:
Telephone:
E-mail Address:
Model:
-Select One-
10000
10000 ADP
10250
10000-CS
10000ADP-CS
10250-CS
10000MDP
Serial Number:
Date:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
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5
6
7
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9
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11
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14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Description of problem:
Select One:
Under Warranty Terms
Not Under Warranty Terms
Already Received a Quote:
No
Yes, $
Purchase Extended Warranty $99.00
(1 year after date of repair)
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