richmond furniture gallery furniture warranty/repair form

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Richmond Furniture Gallery Furniture Warranty/Repair Form Please fill out form completely: In order that we may process your request in an accurate and timely manner, please complete this form in full. If the form is not completed in its entirety, it will be returned for further information. Please complete a separate form for each piece. *** ALL FORMS MUST INCLUDE 2 TO 3 PHOTOGRAPHS OF THE DAMAGE*** Photos can be emailed directly to [email protected] Customer Information: Customer Name:____________________________ Date ______________________ Customer Address: _____________________________________________________ City:________________________________ State:___________ ZIP:_____________ Phone: _____________________________ Cell Phone:________________________ Email Address:_____________________________ Invoice Number:______________ Purchase Date:___________________ Delivery/Pickup Date:___________________ Type of Furniture: ________________________Brand of Furniture: _______________ Model Number: _________________Serial Number: __________________________ Was Fabric or Leather Protection Purchased? Circle One YES NO Description of Problem: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Customer Service Mailing Address Phone/Fax: (765) 939-3349 180 Fort Wayne Avenue Email: [email protected] Richmond, IN 47374 Please complete this form and return to our Customer Service Department:

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Richmond Furniture Gallery Furniture Warranty/Repair Form

Please fill out form completely:

In order that we may process your request in an accurate and timely manner, please complete this form in full. If the form is not completed in its entirety, it will be returned for further information. Please complete a separate form for each piece.

*** ALL FORMS MUST INCLUDE 2 TO 3 PHOTOGRAPHS OF THE DAMAGE*** Photos can be emailed directly to [email protected]

Customer Information:

Customer Name:____________________________ Date ______________________

Customer Address: _____________________________________________________

City:________________________________ State:___________ ZIP:_____________

Phone: _____________________________ Cell Phone:________________________

Email Address:_____________________________ Invoice Number:______________

Purchase Date:___________________ Delivery/Pickup Date:___________________

Type of Furniture: ________________________Brand of Furniture: _______________

Model Number: _________________Serial Number: __________________________

Was Fabric or Leather Protection Purchased? Circle One YES NO

Description of Problem:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Customer Service Mailing AddressPhone/Fax: (765) 939-3349 180 Fort Wayne AvenueEmail: [email protected] Richmond, IN 47374

Please complete this form and return to our Customer Service Department: