Equipment Exchange Form

Request for Equipment Exchange Form
Customer Name*
Red Bolt Account Number
Service Address*
Phone*
Email Address*
example@example.com
Reason for Exchange*
By signing this form, I understand that a $20 cleaning fee plus tax, per device, will be assessed if the equipment needs cleaning. If the equipment is returned unusable (e.g. returned without power cord or damaged) I am responsible for full retail value of the equipment.
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:

Request for Equipment Exchange Form