Electronics Board Repair Form

  • JewlTronics
  • 1622 Eastwood Drive
  • Kannapolis NC 28083
  • 704-932-8002
  • JMac Electronics
  • 18942 Molly Springs Rd.
  • Oakboro NC 28129
  • 704-322-8849

Customer Name : __________________________

Location :_________________________________

Date Shipped :_____________________________

Machine Type :_____________________________

PCB Number:______________________________

PO#:_____________________________________

Description of problem:______________________________________________________

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*************************** Internal Use *****************************

Date IN:________________ Date Out:________________
Serial #: ________________ Labor Rate:_______________
  Parts Used:_______________
  Shipping :_________________