KEH Camera Repair

4900 Highlands Pkwy SE

Smyrna, GA. 30082

www.KEH.com
repair@keh.com
770-333-4210

Repair Form
Please fill out this form completely and include payment information. Alternative methods of payment would need
to be communicated by phone at 770-333-4210 or email at repair@keh.com.

Name: _____________________________________________________________________________________________
Bill To ______________________________________
Address:
______________________________________

Ship To ______________________________________
Address:
______________________________________

Phone #1: ______________________________________

Phone #2: ______________________________________

Email: _____________________________________________________________________________________________
List items that you are sending in for Repair.
Serial Number

Manufacturer

Model / Description

Circle any accessories that you might be including in with the items.
Front Lens Cap
Rear Lens Cap
Filter
Case
Manufacturer's Box
Body Cap
Strap
Battery
Memory Card - size : _______________
Other : _________________________________________________________________________________________
We recommend removing any accessories that are not needed to recreate the problem.

Problem - brief description of the problem you are having with the equipment.

Pre-Approved Amount:

Repair $_______________ + Shipping $__________

** See Repair Prices for pricing information.**

Total $_______________

Accepted forms of payment:

Visa
Master Card
American Express
Discover
(circle one)
Card Number: ___________________________________________________________ Exp. Date: _________________
CSC Number: ______________
KEH reserves the right to re-estimate the repair if the cost exceeds the flat rate pricing.

PayPal payments please email repair@keh.com before sending payment.

Signature _____________________________________________________________

Date ____________________

Your signature with payment information is your approval to start the repairs at the Flat Rate Price.

** All items sent for manufacturer's warranty or recall will be subject to customer - paid shipping costs.
*** If the item(s) was purchased from KEH Camera and is still under the 6 month KEH Camera warranty,
please contact our sales department at 770-333-4200.
**** KEH is not responsible for any loss, time or expense incurred while your item is being serviced.
KEH is not responsible for items left over 30 days.