Name:________________________________________

Address:______________________________________

City:____________________ State:____ Zip:_________

If under Manufacturers Warranty:
Date Purchased:______ Place Purchased:____________

Phone #:___________________

E-mail:(opt)___________________________

Complaint: _____________________________________

______________________________________________

______________________________________________

______________________________________________

Please be sure to include our minimum $90.00 deposit and $20.00 return shipping fee or if your unit is under manufacturers warranty a copy of the bill of sale.

Mail to:
C. C. Bell Electronics, Inc.
6506 North Broadway
St. Louis, MO 63147
Attn: Main-In Service