Owner’s Name : __________________________________________________________________________________...; Shipping Address: _______________________________________________________________________________...; Phone Number: ________________________________Fax Number: ________________________________ Email- Page 27

Micro-Tech Series 

Power Amplifiers

page 27

Operation Manual

Crown Factory Service Information

Shipping Address: Crown Factory Service, 1718 W. Mishawaka Rd., Elkhart, IN 46517

Phone: 1-800-342-6939 or 1-574-294-8200   Fax: 1-574-294-8124

Owner’s Name :  __________________________________________________________________________________________________________________________________________________________________

Shipping Address:  ________________________________________________________________________________________________________________________________________________________________

Phone Number: ________________________________Fax Number: ________________________________ Email __________________________________________________________________________________

Model: __________________________________________________________________________________ Serial Number: __________________________________________________________________________

Purchase Date :   _________________________________________________________________________________________________________________________________________________________________

NATURE OF PROBLEM

     (Be sure to describe the conditions that existed when the problem occurred and what attempts were made to correct it.)

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 Other equipment in system: ________________________________________________________________________________________________________________________________________________________

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 If warranty has expired, payment will be:   

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 Cash/Check       

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 Visa       

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 Master Card       

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 C.O.D.        

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 Purchase Order for Crown Dealer

                                                                 Card Number:___________________________________     Exp. Date:___________________  

                                                                 Signature:______________________________________________________________________

ENCLOSE THIS PORTION WITH THE UNIT. DO NOT MAIL SEPARATELY.