Chair Repair Request

Name:
Company:
Date of Purchase:
Month Day Year
Phone Number:
Fax Number:
E-mail Address:
Mailing Address:
- Chair Sticker Info
  Please provide ALL the information from the sticker on your chair.
- What’s Wrong?
  Please describe what is wrong with your chair – be as specific as possible.
- Who sold you the Chair?
  If possible, please tell us where and/or who sold you the chair.
Should be Empty: