Camera Service Repair Form
	For further assistance please contact our HelpDesk: 0800 222 666

First Name		Surname
Company Name
	Do you have an Account with Canon? YesNo
Account Number		Purchase Order #
Delivery Address/PO Box
Town
Email Address
Daytime Contact No		Mobile No

Model Non Repairable list				What is this?
Serial No				Where is this?
Product Purchased in NZ	Yes No

Only supply accessories relating to the fault. Canon NZ is not responsible for lost accessories or media cards

Accessories (list all items sent)
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