Request for Equipment Exchange Form

Request for Equipment Exchange Form

Revised 10/1/24
This form is to be used only for Red Bolt Broadband service. Any changes to an existing CDEC electric account must be made separately on the form designated for such changes.
Customer Name*
Red Bolt Account Number
Service Address*
Phone*
Email Address*
example@example.com
Reason for Exchange*
Label Information on Equipment Being Returned
FSAN for Router Returned:
S/N for Wi Fi Extender Returned:
If the managed router or WiFi extender equipment needs cleaning, there will be a $20 cleaning fee plus tax, per device, assessed.

If the equipment is returned unusable, (i.e., returned without power cord or damaged), Customer is responsible for full retail charges of the equipment.
$20.00 cleaning fee, plus tax, required?:*

Yes:No:
Full retail charge of $160.00, plus tax, required?*

Yes:No:
FSAN for New Router Assigned:
S/N for New Wi Fi Extender Assigned:
Signature*

Clear
Date

MonthDayYear
Date
1821 Clif Lear Ave. / PO Box 1087 / Grants, New Mexico 87020 / redboltbroadband.com / Ph: 505.876.2005 / Fx: 505.287.2234
Should be Empty:

Label Information on Equipment Being Returned