Mail In:

Customer Information Sheet

Please , fill out and send in with your device

Name: ________________________ Address: ________________________ 

City: ________________________  State: ____________ Zip: ____________

Contact Number: ________________________

Alternate Number: ________________________ 

Email Address: ________________________

Device Make and Model: ________________________ 

Device Imei or ESN (serial number): ________________________

Explain problem(s) with device_________________________________ 



Send only your phone and battery. Do not send your charger, battery door, SIM card, or memory card. We are not responsible for any additional items.

Carefully package your phone in small box or padded envelope. Please request delivery confirmation or tracking number. You may want to insure package for your safety.

We will contact you within 24 hours of receiving your phone to provide you with an estimate. Upon your approval and receiving payment, we will repair your phone and ship it back to you immediately. If you decide not to repair your phone then a $20 shipping fee will be charged to ship your phone back to you.

We accept all major credit cards.

___________________________ ___________

Customer Signature                            Date

Celltech Cellular Repair wants to Thank You for your business and welcomes you to call with any questions (816) 505-1539