Please print this page and send the completed form along with your phone to
the Cellular Clinic Repair Center

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 Leather
VPA H/Free
AC SIM
Describe Problem:

Yes - Proceed with the repair No - Return the product as is - $35 Estimate fee applies

Signature _____________________________________________________
We Require Your Authorization To Complete This Repair

NOTE:

• Warranty phones must be accompanied by POP
• $35.00 estimate refusal charge will apply to quotes refused or returned
• Hand sets will become the property of Cellular Clinic quotes not responded to within 30 days
• Fault rate repair does not include the replacement of battery or missing accessories
• Maximum repair cost - excluding LCD is $150.00
• I understand certain modifictions MAY void my warranty
• Customer is responsible for all related shipping expenses.(Please add $10.00 for return shipping.)

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 Cellular Clinic to charge my credit card
/ __________________________
Method Card Number Expiry Date Signature

Cellular Clinic Repair Center
3339 Bloor st West Unit 19.
Toronto, Ontario
Canada
M8X-1E9
Tel 416-840-7674
Fax : 416-623-6626
www.cellularlinic.com
info@cellularclinic.com 		Repair Center Hours: Monday - Friday 10.00 am - 6:00pm
Express repairs received after 5:00 pm will be processed next business day.

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