Name
Title
Company/School Dept.
Address
City
State
Zip
Country
Phone
Fax
Email Address

Please contact me via: Phone Fax Email

My UNICOM service contract # is:

If you do not currently have a service contract with UNICOM, you can submit this request for service or support at an hourly rate. If you would like information on obtaining a service contract, please contact us at moreinfo@unicom-inc.com.

Equipment Location (School and Address)
Contact Person (If different from above)
Phone Number of Contact Person
School Hours
Type of Unit Needing Repair (Make, Model)
Serial Number of Unit
Is the unit under warranty?

Please describe the problem here:

Comments: