PRINTER/SCANNER REPAIR SUBMISSION FORM
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:
  ATTN:
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:

or
** 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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