Return Authorization Form - Geochron
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2RETURN AUTHORIZATION FORM
Please include this form with your Geochron
Customer: __________________________________________________________________
Ship to: ____________________________________________________________________
City: _____________________________________ State: _______
Zip Code: __________
Main Phone: ___________________________Alt Phone:_____________________________
Email: _____________________________________________________________________
Serial # of unit (Located on the back, bottom middle of unit): _________________________
Check Box for:
Full Rebuild (Units Built prior to 2015)
Repair Only (Warranty units or
units manufactured after 2015)
Lighting Upgrades:
Mapset Upgrades:
Electronic Ballast with CFL Bulbs – n/c
Geopolitical or Existing Mapset – n/c
LED Lighting System - $145.00
Topographical Mapset - $50.00
Sunlit LED Analemma - $75.00
Ham Radio Edition - $99.00
Sunlit Analemma & LED Lighting - $175
Mix Map – 2 Geo and 1 Topo - $99.00
Mix Map – 2 Topo and 1 Geo - $99.00
Front Panel Upgrade (See Guide for cost)
Specify finish ______________
Trim Color__________
(Black, Silver or Gold)
List Specific Problem or Damage Description:
Billing information: Billing Address Same as Ship to:
Yes
No – Complete Below
Name on Credit Card: _________________________________________________________
Billing Add: ______________________________ City: ___________ State: ___ Zip: ______
Payment (circle):
VISA
MASTERCARD
AMERICAN EXPRESS
DISCOVER
CHECK
Credit Card # _____________________________Exp Date: ________ Security Code: _____
Toll Free
800-342-1661
Geochron Ship To Address:
Fax
503-445-4764
Email
13851 Beavercreek Rd, C-103
Website
Oregon City, OR 97045 USA
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