LASERTRON  Wants to Help YOU!
		Location:____________________			Date:______________
		My Name:_____________________			Phone#________________
		Best Time to Call Me:_____________________			Ext.________		PO# ________
		Number of Packs / Stations Down Right Now:________					Rec'd:_______________
				** The following is critical for filling your order **
ORDER FORM FOR PARTS AND REPAIRS					LASERTRON USE ONLY
Date		Packaged	Shipped		Date	Shipped
Shipped		By	Via	Tracking Number	Shipped	Via	Tracking Number
LTE USE					Sending	Serial # of	Unit Price	Total Cost
ONLY		Quantity	Color	Description of Materials Ordered	Repair Back	Repair
					Y /  N		.
					Y  /  N		.
					Y  /  N		.
					Y  /  N		.
					Y  /  N		.
					Y  /  N		.
					Y  /  N		.
		1.  FAX COMPLETED FORM (WITH TRACKING NUMBER)					Sub Total
	>>>	2.  TAG ALL DEFECTIVE PARTS FOR SHIPMENT					S & H
	>>>	3.  FILL OUT EQUIPMENT REPAIR FORM BELOW  FOR RETURNING PARTS THAT NEED REPAIR					Tax
		4.  PLEASE REFER TO YOUR SERVICE PLAN CONCERNING ADVANCE SHIPPING AND PRICING					Total
EQUIPMENT REPAIR FORM				Arrival Date:                        Time:			REC'D
**Please list each item individually**				Shipped via:
Tag	TYPE OF EQUIPMENT		COLOR	DESCRIPTION OF PROBLEM			SERIAL #	PARTS
#								MISSING
A
B
C
D
E
F
G
H
* Fill out the EQUIPMENT TRACKING TAGS, remember to mark each piece of equipment individually. (Ex: Tag A, Tag B, etc…)
	PLEASE CIRCLE WHICH SERVICE YOU WOULD LIKE FOR RETURN SHIPMENT						REQUESTING
		*Please specify if Saturday delivery is requested w/ Next Day service.					ADV. SHIPPING?
		*NEXT DAY      2-DAY SERVICE      3-DAY SERVICE      GROUND SERVICE
				*Change of address effective 10/11/2004
	LASERTRON -   Manufacturers of LASERTRON Game Systems					Phone: (800) 897-8766
	251 Meyer Road      Amherst, NY 14226					Fax: (716) 835-9510
			Our address has changed..have you updated your records??