Order Parts
Dogpatch Music Instrument Repair Request Form
9-12 Rashik Hazari Lane
Chattogram, Bangladesh 4203
Store TEL: 1732 959 934
** Cut and paste information below into an email or doc, fill out the info and send it back to mohammad@dogpatchmusic.com.
Date of Order Request: |
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Estimated Date/Need by Date: |
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Tour/Gigs/Travel Plans: |
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SECTION I - INSTRUMENT INFORMATION
Instrument Category |
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Select Type |
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Strings |
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Percussion |
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Brass |
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Wind |
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Keyboards |
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Electronic |
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Folk/World |
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Other (If other provide notes below) |
Instrument Detailed Description: |
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Instrument Brand Name: |
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Instrument Model Name: |
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Instrument Serial #: |
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Purchased Origin (On-line, Store, 2nd hand) |
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SECTION II - CONTACT INFORMATION
Requestor’s First Name |
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Requestor’s Last Name |
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Name of Institution /Corporation if Applicable |
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Address Line 1/ Street Name |
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Address Line 2 / Street Number |
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Postal Code |
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District Name |
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Next to Business Entity |
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Building Name |
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Near/above Building or Landmark |
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Other Known Place/Location |
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Suite # |
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Apt # |
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Floor # |
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Telephone # Home/Primary |
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Telephone # Mobile |
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E-Mail Address 1 |
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E-Mail Address 2 |
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Special Instructions if delivery |
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PART(S) REQUEST ORDER INFORMATION
Description of Instrument |
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Line Item # |
QUANTITY |
MANUFACTURER PART NUMBER |
SKU # Code # |
MANUFACTURER (Preferred or other Brand Part# substitute) |
Unit Price List |
1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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Additional Information |
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SECTION III – SHIPPING OR PICK UP OPTIONS (Pick up part at the store or ship to your location)
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Select from the following options below: |
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Pick up parts at the store |
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Get part(s) cost estimate before ordering |
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Get notifed by e-mail or Call if part is unavailable or back-order |
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Get your approval If substitute parts are available prior to ordering |
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Get notified by e-mail or Call if repair estimate has changed |
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Get notified by e-mail or Call if part delivery date is delayed or no ETA |
2 |
Ship Parts to your location |
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Get part(s) cost estimate before ordering |
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Get notifed by e-mail or Call if part is unavailable or back-order |
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Get your approval If substitute parts are available prior to ordering |
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Get notified by e-mail or Call if repair estimate has changed |
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Ship parts to the address/location provided via courier |
SECTION IV – SEND US PICTURES OR VIDEO
Send pictures to mohammad@dogpatchmusic.com
SECTION V – PAYMENT INFORMATION
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Price listed do not include cost of replacement parts
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Any items left in the store must be accompanied by a Dogpatch Music Repair form
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Actual rates may vary and are subject to change based on part’s availability, etc.
Change in estimate/work:
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You will receive a call from Dogpatch Music Services with estimates and timeline for repairing your gear.
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If we need to order part(s) we will contact you prior to ordering and provide a revised estimate
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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.
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We accept payment by phone with B-Kash, Credit Card (Visa, Mastercard, AMEX) or Cash-On- Delivery.