Berkshire Instrument68611 LaSalle RoadMontrose, CO 81401Phone 800-443-0083, 970-240-9606 Fax 970-240-9643
REQUEST FOR SERVICE
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Date___________________
Name:____________________________________Company:________________________________________Address:________________________________________City______________________________________Address__________________________________________Country__________________________________State:______________________________________Zip Code____________________Phone:________________________________________Fax________________________________________Email______________________________________INSTRUMENT INFORMATION Model No:__________________________________Part No:_____________________________________Serial No:___________________________________Purchase Date________________________________Hours in service before unit failed____________Airplane Make/Model______________________________Airplane N Number____________________ Year:_______________Panel Tilt Degrees_______________Description of problem: