REPAIR SERVICE FORM

DATE*

Contact Reference Number

Contact Name*			Contact Phone*
Contact Email*			Confirm Email*

Collection Address

Delivery Address for Returned Product

Product

Purchase Date

Style #*

Label along internal lining

PO #

Label along internal lining

Product Name

Product Receipt

receipt has to be attached if available

Add Photos			Photos must be smaller than 100KB.
Front of Item*				Item Defect*

Repair Service Boer
Panoven 50
3401 RB IJsselstein
The Netherlands

Telephone:	0031 - (0)30 688 2049
Fax:	0031 - (0)30 688 4992

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