Please enter all information accurately, incorrectly entered information will cause delays in the processing of your repair request.

Enter your company and contact information in the spaces below: ( * denotes required field)
  *Company Name:
  *New Customer?

     New customers, please select "yes"

  *Contact Name:
  Contact Phone:
  *Contact E-Mail:
Please select the type of contract/payment agreement you have with us. If you are a new customer select the "Time & Materials" option and enter an authorized repair dollar amount per unit.
** NOTE: All T&M printers/scanners will be charged a $50.00 Diagnostic Fee per unit.
Warranty    Enter date of warranty purchased with product.
Maintenance Contract    
Flat Rate Contract    
Express Contract    
Time & Materials $ + Parts - Per Unit MINIMUM
  MAXIMUM: $ Enter an authorized repair dollar amount per unit.
Enter information for the printer/scanner that is being repaired in the spaces below.
If multiple printers/scanners are being submitted please separate with a comma:
*Manufacturer & Model
*Serial Number:
*Problem Description
Enter the address you would like the printer/scanner returned to after it has been repaired:
*Ship repaired printers/scanners to:
Do you require MHL to send you a shipping container?
Number of units requiring containers: @ $15.00 + shipping per container
Acknowledge your acceptance of the Terms & Conditions of this agreement.
*I have read and accept the Terms & Conditions (you must check this box to continue)
Anti-Spam Check: security code
Enter the code above:

** Please print a copy of the form for your own records before sending. Sending the form may take a few moments, you will receive a confimation notice on the screen when the form is successfully submitted **
If you have any questions or problems submitting this form please call MHLCP Customer Service at
1-866-MHL-4FIX (1-866-645-4349)

MHL Computer Products Phone: 419-897-9700 Toll-Free: 800-343-1764

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