EmailMe Form - Fixed Cost Repair Registration Form

Customer Name *

First Last

Please supply your title, first and last name.

Customer Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Please supply an address for future correspondence.

Contact Details

Please supply contact details so we can get in touch with you.

Email Contact *

Please supply a working email address.

Landline Telephone *

Please supply a landline telephone number. If no landline is available, please enter your mobile number here and below.

Mobile Telephone *

Please supply a mobile phone contact number. If no mobile phone number is available, please re-type your Landline Number.

Television Details

Please send us the information required below about your television. If you can, be as accurate as possible as this will allow us to process your request faster.

Brand (Make) of Television *

Please select the brand of your TV.

TV model number *

Please enter your TVs model number. This can be found on the centre label on the rear of the TV or on the original packaging supplied with the TV.

TV Serial *

Please enter the long serial number of the TV. This can be found on the centre label on the rear of the TV (usually typed under the barcode). You may also find it on the original packaging supplied with the TV.

TV Fault Info *

Attach picture of TV set. *

Please upload a photo of the front of your TV set - preferably powered on if possible.
Please ensure that this is a face on image, showing the full screen and frame, in a well lit room, with no flash enabled.

Size limit is 5Mb.

We accept the following file types:
JPG, JPEG and PNG

Attach picture of Rating Plate *

Please upload a photo of the centre label on the rear of the TV. Please ensure that this is a face on image, in a well lit room, with no flash enabled.

Size limit is 5Mb.

We accept the following file types:
JPG, JPEG and PNG.