Welcome to the CYPRES Servicing Form
Use this form ONLY if returning your CYPRES to SSK Industries!

This page is best used with
Internet Explorer version 4.0 and higher or Netscape Navigator version 6.0 and higher

Please complete the following information and then click the SUBMIT button

Your Name: Your email:

You may return up to 4 CYPRES using this form, ONLY if all contact information is the same for all devices!

Unit
#
Serial Number DOM Model Pins Units 4/8 Year
Maintenance?
Replace
Battery?
Battery Date Other
Reason?
1 / /
2 / /
3 / /
4 / /

  SENDER OWNER
(Click if same as: Sender)
Company or Name:
Attn or C/O:
Street:
Town:
State/Province:
Country:
Post Code:
Daytime Phone:
Evening Phone:
Fax:
email:
  Invoice To: (with postal mailing address)
(Click if same as: Sender   Owner )
Ship To:
(Click if same as: Sender   Owner   Invoice To)
Company or Name:
Attn or C/O:
Street:
Town:
State/Province:
Country:
Post Code:
Daytime Phone:
Evening Phone:
Fax:
email:

Preferred
Shipping:

(Only the Post Office will deliver to a P.O. Box.)
(International customers click here for important information!)
(Canadian customers click here for important information!)
(Click here for www.UPS.com to see transit times)

Payment
Method:
Credit Card Billing Information
Required if payment method is a credit card.
(Click if same as:
Sender  Owner  Invoice To  Ship to)
Name on Card  
Credit Card Number  
Expiration Date (mm/yy)  
'V' Code   What is this?
Card Billing Address  
City  
State or Province  
Country  
Zip/Postal Code  
Contact Phone Number  
Relationship of Card Holder
to Billing Contact  

Please Note:
If paying by Credit Card, due to new and more stringent requirements, you must provide the following information when returning your Cypres:
    + Name or names as it appears on the credit card
    + Card expiration date (as it appears on the credit card)
    + "V" Code # - (right 3 digit verification number on back of card on the signature strip for Visa/MC or 4 digit non-embossed number on front of AMEX)
    + Credit card billing address - (where the credit card bill is sent)
    + Phone number where the credit card holder can be reached


Remarks:

Remote -54.204.163.26-
Local -192.168.1.153-