Company Name 

First Name              

Last Name          

Address Street  

Add. Suite/Apt  

City                      

State                   

Country              

Email Address   

Confirm Email   

Telephone         

EL Display being sent in for repair:

Planar EL Display EL series  

    Model:

Finlux /Planar MD series       

    Model:

Sharp EL Display LJ series    

    Model:

What make and model machine do you have? (This is important for us because you may qualify for a replacement display from Capetronics Inc. should your display cannot be repaired)

Describe your problem you are having with your display as best you can: