CUSTOM REPAIR FORM
Customer Name for IEMs: _______________ Contact Name________________
Band/Group/Dealer (If Applicable):_________________________________
Monitor Issues:
Billing Information
Please provide us with the following contact information so that we can get in touch with you
Phone:________________________ Email:________________________________
Shipping Address*
Please state if this address is a residence or business.
Street
Address:_______________________________City:__________________________
State/Province:_________________________Zip Code: _____________________
Country:______________________
*NOTE: ALL REPAIRS ARE SHIPPED BACK AS COMPLIMENTARY UPS GROUND SHIPPING with
signature required
LET US KNOW IF YOU PREFER
2ND DAY AIR (+) OR
NEXT DAY AIR (+)
Please Send Your Repair in with this document to the following address:
Ultimate Ears
Attn: Custom Repairs
3 Jenner Suite 180 Irvine, CA 92618
UE Repair Form Version 1_6.27.13
