33
CORE
™ Outdoor Power
Authorized Service Request Form
Date:_______________________
Company or Institution Name
[
if applicable
]
:
_____________________________________________
Name of Purchaser
[
or name of contact person for Company or Institutionally-
owned product
]
:
________________________________________________
Physical Return Delivery Address
[Note:
we are unable to deliver to PO boxes
]:
Street Address:
________________________________________________
Address continued:
________________________________________________
City: _______________________, State / Province: __________________
Country [
circle which applies
] USA/Canada Zip/Postal Code: ___________
Correspondence mailing address
[
if different from delivery address
]
:
Street Address
[
or PO Box
]
:
________________________________________________
Address continued:
________________________________________________
City: _______________________, State / Province: __________________
Country
[
circle which applies
]
: USA / Canada Zip/Postal Code: __________
Daytime Phone Number: ____________________________
Extension: _________ Email Address: ____________________________
Mark (X) Your Preferred Method of Contact:
Phone ____, Email _____, Postal Mail _____
Date of original purchase: ___________________________
