Repair Requests

We work closely with our manufacturers to ensure that your products get to you in perfect working condition every time. If a problem ever occurs, we will promptly take the appropriate action to get the problem resolved quickly so you can get back to business.

Contact Information

First Name

Last Name

Title

Company

Phone

Fax

Billing Address

Street Address

Address 2

City

State

Postal Code

Country

Repair #1

Product Type

Quantity

Manufacturer

Part #

Serial #

Under Warranty

Repair #2

Product Type

Quantity

Manufacturer

Part #

Serial #

Under Warranty

Repair #3

Product Type

Quantity

Manufacturer

Part #

Serial #

Under Warranty

Shipping Address (If different from above)

Address

Address 2

City

State

Postal Code

Country

Shipping Information

What carrier would you like B.W. Rogers Co. to use to ship your repair back to you?

How would you like B.W. Rogers Co. to ship the product?

Would you like B.W. Rogers Co. to insure the shipment of the product?

If you would like B.W. Rogers Co. to bill the cost of shipment to your customer account with your preferred carrier, please specify your account number:

Other Reasons for Repair:

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