CUSTOMER SERVICE REQUEST

Person Completing Form Email Address
CUSTOMER INFORMATION
CONTACT PERSON
ORGANIZATION
Phone: Ext.
Fax:
Street:
Room #
City:
Email:
Make sure it is the full address, e.g.(leonard.smith@state.co.us)

REASON FOR CONTACTING CUSTOMER SERVICE



PRODUCT INFORMATION
Product Type Requiring Service
Product ID Requiring Service    
(This could be a "StockNumber", "Serial Number" or a "MOS Project Number")
Date Received Product
(00/00/0000)
Sales Order Number (SO) Purchase Order Number (PO)

Describe the problem with the product.

IMPORTANT NOTICE
You may or may not be assessed a service charge for this service order.
If you DO NOT receive an email confirmation of your on-line service order, there might have been an error with the Internet provider or email services. It is most likely that the order was NOT received.
Contact CCi James Tafoya or Call 1-800-685-7891