Mailing/Shipping Address:
ENMET
680 Fairfield Court
Ann Arbor, MI 48108
Phone: 734.761.1270
Fax: 734.761.3220
Service Request Form
Product Name or Number:
Product Serial Number:
Describe Problem or Needed Service:
Warranty Claim?
Yes
No
CUSTOMER INFORMATION
Shipping Address:
Billing Address:
Contact Name:
Email:
Phone #:
Fax #:
PO/Reference
#:
PAYMENT METHOD
COD
VISA/MasterCard
American Express
Security Code:
Card Number
Exp. Date
Name as it Appears on
Card:
RETURN SHIPPING METHOD
UPS Ground
UPS 3 Day
UPS Next Day
UPS ND Air
UPS 2 Day Air
Select
Air
Saver
UPS Account #:
FedEx Ground
FedEx Air
FedEx Air
FedEx Air 2
FedEx Air
Express Saver
Overnight Std.
Day
Overnight P-1
FedEx Account #:
Insure Shipment:
Yes
No
Insurance $
Amount:
Rev.2 – 9/15/2016
ENMET
Service Request Form
EX-5155 Manual Draft.docx