Please provide a brief description of problem/need for repair:
Is AC/DC cord included? ---YesNo
Is a replacement needed? ---YesNo
If a replacement is requested, please provide a COMPLETE "ship to" address below (including zip code).
*This form MUST accompany any items that are returned to the AIM Library in need of repair. NO replacement materials will be sent without this form COMPLETED with all the necessary information.
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