RMA

Service Form

Ship All Items to the below address

Burghardt Radio Repair Inc.
1320 13th Avenue SE - Unit 48
Watertown, SD 57201

Customer Information
Below Information is the same as credit card billing
Full Name And Address

Yes

No
Contact Info
Telephone Numbers
xxx

Home
Work
Cell
Fax
Call Sign

Product Information
Make
Model
Serial Number

EMAIL-

Yaesu
FT 100D

Is this a Warranty or Non-Warranty Repair? Check Appropriate Box below

Warranty Service

Yes

No

If Yes please provide:

xx

If No, please read and agree to the charges below by

checking the box.

Yes I understand the estimate cost is $37.50 and I am

to pay return shipping whether an estimate is done or
not.

Purchase Date
Invoice Number

Check here -->

xxxx

What the Symptoms does the radio have?

DSP and CW problems (not Working)

Any additional details about the radio or repairs needed?

Please all repairs the radio needed, including maybe frequency alignment.

Select Payment & Enter Additional Information

Is the credit card info the same as the above contact information?
YES
NO
If you selected NO please enter Name as it appears on the card and full billing address
VISA
MasterCard
Discover
Card Number
American Express
Card Expiration
COD
Security Code