500 South Ewing Ave Suite D, St. Louis mo 63103

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Date	22.01.2022
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60ac89a7e55ccb12fe1b8b24 Work Authorization Form

500 South Ewing Ave Suite D, St.Louis MO 63103

T-2163

Tel:
Date:

Name:

Invoice#:
Email:

IMEI / Serial:
Ticket#:

Device:

Device Issue:

Diagnostic Notes:

Passcode / Pattern
Price:

Passcode:

Pattern:

Device Pre-Repair Conditions:

Deposit:

Due:

Payment Information:

Touch Functionality:
Mute Switch: Home Button:

Volume Button:

Terms & Conditions:

This warranty is specifically for defective parts that are not functioning. Accidental damage is not covered by the warranty. No returns or exchanges will be accepted from further damaged phones or broken screens.

Sales Person:

Thank you for your business
Customer Signature:

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