Payment Information (Name, Address, and Credit Card):

First Name

Last Name

Street:

City:

State:

Zip:

Credit Card:

Number:

Exp. Date:

Phone/Email

Home Phone:

Day Phone:

E-Mail:

Repair Items

Please list each component separately, example: body, lens, flash, winder, etc.

Item Brand & Model Serial Number

1.

2.

3.

4.

5.

Accessories enclosed which are needed to diagnose the problem:

Battery Power Cord AC Adapter
(required for video repairs)

Film

Remote Video Tape

Lamp

Memory Card Sample Negs & Prints

Other:

Condition of Equment

Please check all that apply:

Impact damage Won't power up Flash won't fire

Liquid damage

Won't load the film/tape Premature rewind

Sand damage

Won't advance Won't rewind

Won't focus/out of focus

Please describe the circumstances under which the problem occurs and any other symptoms which may help diagnose the problem:

Pre-approved amount - Return shipping in the continental United States will be $7.95 for up to ten pounds. Multiple packages and items over ten pounds will be billed at actual UPS rates.

Estimate only Refused estimates will be billed as follows (including return shipping):

- 35mm and APS point & shoot, lens, flash	$15.00
- 35mm and APS SLRS’, slide projectors, movie projectors	$25.00
- Video cameras, digital cameras	$60.00

Clean & Check only - Do not use this option if you are having problems with your equipment. Clean and check is only applicable on fully functional equipment. Contact us at Repairs@CarlisleCamera.com or 717-249-4007 for pricing information.

Note: New batteries are not included in camera repair estimates. Please check here if we may supply and bill for a replacement battery, if necessary.

Only one more step! Please click the Verify Order button below. This will give you the chance to examine your order one last time before you actually submit it to be processed.