Dogpatch Music Instrument Repair Request Form
262-267 Rashik Hazari Lane
Chattogram, Bangladesh 4203
www.dogpatchmusic.com
Store TEL:  1732 959 934

 

Date of Order Request:

 

Estimated Date/Need by Date:

 

Tour/Gigs/Travel Plans:

Notes here

 

SECTION  I - INSTRUMENT INFORMATION

Instrument Category

 

Use Drop down menu Selection

 

Strings

 

Percussion

 

Brass

 

Wind

 

Keyboards

 

Electronic

 

Folk/World

 

Other (If other provide notes below)

 

Instrument Type / Description:

 

 

 

Instrument Brand Name:

 

Instrument Model Name:

 

Instrument Serial #:

 

Purchased Origin (On-line, Store, 2nd hand)

 

 

SECTION II - CONTACT INFORMATION

Requestor’s First Name

 

Requestor’s Last Name

 

Name of Institution /Corporation if Applicable

 

Address Line 1

 

Address Line 2

 

Postal Code:

 

District Name:

 

Next to Business Entity:

Near/above Building or Landmark:

Other Known Entity:

 

Suite #

 

Apt #

 

Floor #

 

Telephone # Home/Primary :

 

Telephone # Mobile :

 

E-Mail Address 1:

 

E-Mail Address 2:

 

Special Instructions

 

 

 

 

PART(S) REQUEST ORDER INFORMATION

Description of Instrument

 

Line Item #

QUANTITY

MANUFACTURER

PART NUMBER

SKU #

Code #

MANUFACTURER (Preferred or other Brand Part# substitute)

Unit Price List

1

 

 

 

 

 

2

 

 

 

 

 

3

 

 

 

 

 

4

 

 

 

               

 

5

 

 

 

               

 

6

 

 

 

 

 

Additional Information

 

 

SECTION III – SHIPPING OR PICK UP OPTIONS (Pick up part at the store or ship to your location)

 

Select from the following options below:

1

Pick up parts at the store 

 

                Get part(s) cost estimate before ordering

 

                Get notifed by e-mail or Call if part is unavailable or back-order

 

                Get your approval If substitute parts are available prior to ordering

 

                Get notified by e-mail or Call if repair estimate has changed

 

                Get notified by e-mail or Call if part delivery date is delayed or no ETA

2

Ship Parts to your location

 

                Get part(s) cost estimate before ordering

 

                Get notifed by e-mail or Call if part is unavailable or back-order

 

                Get your approval If substitute parts are available prior to ordering

 

                Get notified by e-mail or Call if repair estimate has changed

 

                Ship parts to the address/location provided via courier

 

SECTION IV – UPLOAD PICTURES OR VIDEO

1

 

2

 

3

 

4

 

5

 

 

SECTION V – PAYMENT INFORMATION

Note:

  • Price listed do not include cost of replacement parts
  • Any items left in the store must be accompanied by a Dogpatch Music Repair form
  • Actual rates may vary and are subject to change based on part’s availability, etc.

Change in estimate/work:

  1. You will receive a call from Dogpatch Music Services with estimates and timeline for repairing your gear.
  2. If we need to order part(s) we will contact you prior to ordering and provide a revised estimate
  3. If the level of effort or part of the repair service estimate changed prior to the original estimate due to unforeseen cracks, defects, etc. we will contact you directly.
  4. We accept payment by phone with B-Kash, Credit Card (Visa, Mastercard, AMEX) or Cash-On- Delivery.