Chim-Scan Repair Form

Chim-Scan Repair Form
Name *

First Name Last Name
Company Name *
Company Owners Name *

First Name Last Name
E-mail *
We don't sell or share info.
Phone Number *
Please list office phone or cell phone
Date

Month Day Year
Chim-Scan® Serial #
This will be located under the unit's handle and in your manual.
Why do we want to know all of this?

Because it can take up to four business days (depending on your location and how you send it) for your unit to arrive here, this form acts as a packing list for us, so should the box be damaged, we can verify we have everything you sent. Also, this form helps us know who sent the unit and where we need to send it back to; shipping tags don't always give us the information we need.
Preferred Shipping Method for us to send your unit back *

UPS USPS - Mail
SHIPPING Address: *

Street Address

Street Address Line 2

City State

Zip Code
Billing Address

Street Address

Street Address Line 2

City State

Zip Code
Has the company changed location in the last two years?

Yes No I don't know Yes and I listed the new address
**If you want us to ship the repair back to you with UPS - we ship Ground unless you request faster shipping. NOTE: 3rd, 2nd, and Next day shipping are expensive.

Ground is fine 3 day - (only useful if you live in NJ, DE, CT, VT, NH,ME,AZ,NV,OR,CA,WA,ID) 2nd Day 2nd Day - Early AM - 10am - (Usually double the cost of ground) Next Day - (is always over $100) Next Day - early AM - 10am - (Always over $110)
Tell us what's going on, what happened, what it's not doing, or what it's doing, which it's not supposed to do. *
Send us a Photo of the broken part.
Upgrades / Updates

No, Just fix it Not right now, but send info on what can be done I'm open to updating/upgrading the unit, but want info before I decide
How does this help you??

By filling this out, you not only help us, but you help your office staff (even if you are the office staff) what needs to go, what you were sending when you sent it, and why you're sending it. If you keep a copy of this, you can track how often you're sending a unit or units back for repair and what needs to be repaired. This way, if you notice you're always sending a cable back for the repair, you can track down the cause.
What are you sending??

Whole Unit - Controller, Camera, Cable, and Case Just the Controller (Part with switches that control camera) Just the Camera Just the Cable Controller and a Camera Camera and Cable Multiple Cameras - please wrap each camera separately Multiple Cables Multiple Whole Units - Please Ship in separate boxes, damage is more likely if units are packed together. No Clue / Not Really Sure
If sending a Controller or Whole Unit - what series or model is it

Model 405, 500, or 402 Series 100 Series 200 or 210 Series 300 Series 250 or 275 Series 211 I have no idea
What type of Image/Video recorder does the unit have

None SD Recorder CF or Compact Flash Mavicap / Floppy Disk VCR DVD Polaroid Camera - was new in 1980 Combo of 2 or more listed
What type of Camera

Auto Focus (built 1989 - 2001) Auto Focus Tilt / AFT ("Brick that moves', could Zoom (built between 1997-2012)) Enviro in a Cheesehead or Cheesebit bracket (1999 - Today) Cheesehead Auto Focus Camera / CAF (built between 2000- 2012) Lighthouse Camera (aka the tower or pole camera (Started being built in 2013)) Lighthouse Tilt ((Works like Lighthouse but can tilt up and down) Started to be built DEC 2020) Tilt Combo Camera / LHTC (is two cameras, one that looks up and the other at 90° with tilt ability (Up camera is Enviro and 90°with tilt is Lighthouse Tilt)) Combo Camera / LHC (is two cameras, one that looks up and the other at 90° (Up camera is Enviro and 90° or side view is Lighthouse)) 3" Round Camera (built between 1990-1999) Cube Shaped Camera (built between 1987-1999) Rectangle Shaped Camera (Brick on a stick, the original Chim-Scan camera) I have no clue
IF your the Office Manager or Warehouse Manager, and have no idea what
Do you need a Call Tag sent to you, or will you be shipping the unit yourself? *

I need a call tag I'm taking it to a Pack 'n Ship store (Side note - Don't insure a package for over $2,000.00, even if you are sending a whole unit. Insure over $2,000 automatically raises the shipping price by $100 for every $1,000 over $2,000) I have a question on what I should ship I have the repair all boxed up and I need the address - Estoban Corporation 1643 Old Hwy 34, Fairfield, IA 52556
Should be Empty:

Chim-Scan Repair Form

Why do we want to know all of this?

How does this help you??

IF your the Office Manager or Warehouse Manager, and have no idea what