Fill, Print and Ship with your iPhone.
In a Rush; send your business card with your iPhone, we will call after diagnosis.
You can also write the info in plain sheet of paper if you do not have the printer handy.
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Payment Method (Choose One):
Paid Online (Fill this Form or enclose receipt with your Phone #):
I will pay by Phone later with Credit Card (Provide Phone # below):
Please charge my Credit Card (Provide Credit Card information below):
Do not send the iPhone 2G or iPod Touch, only send iPhone 4, 3G, 3GS.
Please fill all items marked bold, other fields are optional.
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Name under which you made the payment (We will look up payment with this info, skip if paying later):
Last Name: First Name:
Address to ship your iPhone back to (if not provided, we will ship to Billing/PayPal address):
(No PO Box Address, FedEx will not deliver to PO Box address)
Name( if different than above):
Street:
City State: Zip:
Email to contact you:
Phone # to contact you:
Brief Description of issue with your iPhone:
If Touch Screen Repair, do you want (circle one)? Genuine OEM
How did you found us (circle): Apple AT&T Google Friend Other
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If paid online or by USPS Money Order no need to enter this information (Skip this Section)
You can pay later after Free Diagnosis. We will contact you with above information.
You can choose to provide this information later on the Phone when we call you.
You can also pay with USPS Money Order payable to “Cupertino iPhone Repair”.
Last Name: First Name:
Credit Card #:
Expiration(mm/yy): Security Code (CSC):
Credit Card Billing Address (if different than above):
Street:
City: State: Zip:
Circle One: Free 3 Day Shipping 2 Day Shipping ($5) Overnight Shipping ($10)
If paying by credit card please sign here: that you agree to pay the amount of $ by charging to your above credit card. No need to sign if paid online or by Money Order.
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Send the iPhone preferably in the original box or bubble wrap your iPhone securely.
Do the sync with iTunes. You can take the SIM out or leave it as is.
Turn off your iPhone and put the switch in vibrate mode.
Ship your iPhone 4/3G/3GS to:
CUPERTINO REPAIR
21801 Stevens Creek Blvd # 7A
CUPERTINO CA 95014 (USA)
