EZ Systems Paid Repairs Request Form

Todays Date:

Email address:
Please specify which search engine and or advertisement
How did you find us?


Bill to Address: Include company (if applicable) & name, street address, city, state and zip code.

Telephone Number:

First and Last name:

Fax Number:


Ship to Address: Include company (if applicable) & name, street address, city, state and zip code.
How do you want the unit(s) shipped back? Since you pay shipping it is your choice. We recommend FedX Economy 2 Day Service -please specify.
Shipping Method:
List all models, serial numbers, and problems.
Model(s):
Serial Number(s):
Problem: Please describe issue with as much detail as possible.

Operating System/Backup Software (if known)

Amount of repair in $ US Dollars
Expedite Fee: For an extra $50 we can fix your drive in 2 days (this does not include shipping time) Please specify expedite or our normal turnaround of 1 week.

Bench Fee: If we can find nothing wrong with your drive we will charge you $50 or $150 depending on the drive. All drives are $50 bench fee except 9 Track and 3480,3490/E tape drives. Type accept in this space to acknowledge this condition.

Purchase Order Number: (if you use them - not required)

Payment Method: COD or Credit Card (include #, expiration date & full name on card) Terms for pre-qualified customers only.


Comments / Instructions: