C O A C H
Repair Service Request
Customer Name

 Date
Email Address

 Day Telephone
Return Address (Must be Street Address. Items cannot be returned to PO Box.)

 Apt. or Suite No.
City/State

 Zip Code
Product Info: Type of Product or Style Name Color Registration No. if available
Please describe the nature of the repair that you are requesting:
The $20.00 processing fee should be included for each item. We accept payment by personal check or money order. You may also use your American Express, Diners Club, Discover, JCB, MasterCard or VISA. Please indicate method of payment below.

Personal Check ____                   Money Order ____                   Credit Card ____

Credit Card No. ___________________________________      Expiration Date _____________


Signature _________________________________________________
Please send to:

C O A C H
Attn: Repairs
One Coach Way
Jacksonville, FL 32218

We suggest that you send your item to us via an insured, traceable means, such as UPS insured or insured mail. If you have questions, please contact us at 1-888-262-6224.


Please allow 4-6 weeks for repair processing time. Thank you.