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Customer Information
* Name:
* Phone Number:	xxx-xxx-xxxx
Alt. Number:	xxx-xxx-xxxx
* Email Address:
* Street Address:
* City:	* State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * Zip:
Tanning Unit Information
* Model Number: (From Serial Number label on back of unit)	VA0-PS16E VA0-PS16B VA0-PS16D VA0-PS24P120 VA0-PS26C120 VA0-PS32P120 VA0-PS282F T-PS16E T-PS16B T-PS16D T-PS24P120 T-PS32P120 T-PS24D T-PS26C T-PS26T T-PS282F S-PS16E S-PS16B S-PS16D S-PS24D S-PS24P120 S-PS26C S-PS26T S-PS282F R-PS16B R-PS16D R-PS24P R-PS24D R-PS26T R-PS282F P-PS16E P-PS16B P-PS16D P-PS22B P-PS24B P-PS24D P-PS26T P-PS282F L-PS14E L-PS16E L-PS16B L-PS16C L-PS16D L-PS24B L-PS24C L-PS24D L-PS24P L-PS26T L-PS282F
* Purchase Date:
Store purchased from:
City:	State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Hours on Bed:	* Operating Voltage:
* Serial Numbers:	Canopy -   Bench -
* Description of Problem: Specify Location BENCH:    CANOPY:    STAND UP UNIT:
* Servicer Requested?	Yes No

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