Mailing/Shipping Address:
ENMET
680 Fairfield Court
Ann Arbor, MI 48108
Phone: 734.761.1270
Fax: 734.761.3220
ENMET
Rev.2 – 9/15/2016
Service Request Form
Service Request Form
PAYMENT METHOD
☐
COD
☐
VISA/MasterCard
☐
American Express
Card Number
Exp. Date
Security Code:
Name as it Appears on
Card:
RETURN SHIPPING METHOD
☐
UPS Ground
☐
UPS 3 Day
Select
☐
UPS Next Day
Air
☐
UPS ND Air
Saver
☐
UPS 2 Day Air
UPS Account #:
☐
FedEx Ground
☐
FedEx Air
Express Saver
☐
FedEx Air
Overnight Std.
☐
FedEx Air 2
Day
☐
FedEx Air
Overnight P-1
FedEx Account #:
Insure Shipment:
☐
Yes
☐
No
Insurance
Amount:
$
Product Name or Number:
Product Serial Number:
Describe Problem or Needed Service:
Warranty Claim?
☐
Yes
☐
No
CUSTOMER INFORMATION
Billing Address:
Shipping Address:
Contact Name:
Phone #:
Email:
Fax #:
PO/Reference
#: