Sample Product Repair Order Form 1

Customer Name: Business Name: Date: (First and Last) (Required for delivery to a business address not required for delivery to a home address.) Shipping Address: City Would you like a signature required for return package: Daytime Phone: State Zip/Postal Code No E-mail: Product Name / Model: Firearm Used: Yes Serial : (If applicable to using this Vortex product, include caliber.) Ring Mount Used: (Located on bottom of product, if available) (If applicable, include brand/height.) So we can provide the best service to you, please describe with specific details the issues needing attention: www.vortexoptics.com Vortex Optics 2120 West Greenview Drive Middleton, Wisconsin 53562 USA 800 · 426 · 0048 A Division of Sheltered Wings, Inc..