Repair Shop Submission Form - MarBeck.com

You may use this form for sending your appliance for repair
Please include all of the following information:

Name:
Address:
Address:
(Note: No PO Boxes, please)
City:
State:
Zip Code:
Phone number:
Email Address:
Appliance Brand & Type:
(e.g., Norelco Shaver, Farberware Percolator, etc.)
Model Number:

Please describe the problem with the appliance:

Stated charge for the repair:
__ $29.99   __ $39.99   __ $49.99   __ $59.99   __ $69.99
Other (please state): $____
Method of payment for the repair:
__ Visa   __ MasterCard   __ Money Order ⁄ Cashier's Check
Is payment included with the item? __ Yes   __ No

Ship to:

MarBeck Appliance
303 West 79th Street
Kansas City, MO 64114

Please read and understand the following before shipping your appliance to us:

Return to the Repair Shop.