Please fill up this form and then print this page .Send the completed form along with your phone to
the CellularTech iPhone,Samsung,Blackberry repair and service centre

Customer Information

Company
First Name
Last Name
Address
City
Province
Postal Code
Phone#
Fax#
Cell#
Email Address

Handset Info

Manufacturer

Model

Serial#

ESN/IMEI

Accessories

Battery	Case
USB	Other
Charger	SIM

Describe Problem:

Yes - Proceed with the repair

Signature _____________________________________________________
I here by Authorized Cellulartech.ca to repair my item with out my approval

$25.00 estimate refusal charge will apply to quotes refused or returned on each phone
Hand sets will become the property of Cellular Tech quotes not responded to within 30 days
Maximum repair cost - excluding LCD is $150.00
I understand certain modifications MAY void my warranty
Customer is responsible for all return shipping expenses.

PAYMENT TERMS:
All repair charges are due upon receipt and are payable by cash, certified cheque, Interac, Visa, Master Card or
American Express. No refunds or exchanges available. All repairs are subject to applicable taxes.

I hereby authorize Cellulartech to charge my credit card

		/		__________________________
Method	Card Number	Expiry Date	CVV	Signature

Cellular Tech Repair Centre 365 Evans Ave Suite L8. Toronto, Ontario Canada M8Z-1K2 Tel 416-840-7674 Fax :1-866-406-8252	Repair Center Hours: Monday - Friday 10.00 am - 6:00pm Express repairs received after 5:00 pm will be processed next business day. www.cellulartech.ca info@cellulartech.ca