UR Repair Form
Click for Shipping Label / Click for Shipping Instructions
Today's Date:
PO# / Reference#:

Customer Information:

Account#
Co. Name:
Address:
City:  State: Zip:
Contact Name:
Phone:  Ext:
Bill To Address:
Please check one applicable box below:
Out of Warranty
If out of Manufacturer's Warranty,
*You may wish to Pre-Approve the
limit rate for this item up to $

Manufacturer's Parts & Labor Warranty
If under Manufacturer's Warranty
*Include customers Bill of Sale

United Radio Guarantee
Unit Information:    Model#:   Password:
Serial#:
Please DO NOT send accessories unless related to the problem with the equipment.
Accessories Sent:
Antenna RadioCaseMicClip
ChargerBatteryControl HeadHeadset
Other:
Symptom:
No/Low PowerNo/Low AudioConstant ToneCannot Read/Program
SecureNo ReceiveNo TrunkingDeadBlows Fuse
No SquelchNo TransmitNo PL/DPLFail Code
Other/Specific Details: