SERVICE REQUEST  
Personal Information of Contract Purchaser:  
Equipment Detail:  
Failure Details:  
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I accept the terms of service
I have completed all manufacturer suggested troubleshooting. I acknowledge that if it is determined that the service provided on my product is not covered under the Terms & conditions of my service plan, I will be responsible to pay the service provider for the service call. I may also be responsible for mileage charges outside of a certain radius per my Terms and Conditions.
 
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