AIRCRAFT
  QUALITY
INSTRUMENTS,
INC.

Aircraft Quality Instruments, Inc.
2649 S. Custer
Wichita, KS 67217 (USA)

Phone: (316) 942-9933
Toll-Free: (800) 942-9938
Fax: (316) 942-9975

  REQUEST for SERVICE Form

Date___________________
Company Name   (for aircraft maintenance centers):
_______________________________________________________________
Your Name:_____________________________________________________
Shipping Address:_________________________________________________
Shipping Address:_________________________________________________
City_____________________________State:_________________ZipCode___________
Country_______________________________________ Phone:_______________ Fax_________________Email_____________________

PAYMENT by:
  C.O.D__    Check__    Credit Card__    Call For Payment__
Credit Card

Number: ________________________Expiration_________CVV_______
Credit Card Billing Address  (If same as shipping address check here [ ]. )
Billing Address: ____________________________________________________
City__________________________State:_______________ZipCode_________

How quickly do you want this shipped back to you?
GROUND___     2-DAY___     OVERNIGHT___     CALL WHEN DONE___

INSTRUMENT INFORMATION:

Model No:_____________________ PartNo:_______________________

Serial No:_________________________Purchase Date______________

Description of problem:

 

 

Please complete fields as needed, and send with your instrument.