Service Request Form
Please complete this form and enclose it inside the package with the requested
documents and your returned merchandise.
Please send all Servicing Requests to the following address:
Ultralight Optics, Inc.
ATTN: Service Department
3505 Cadillac Ave. Bldg #H
Costa Mesa, CA 92626
Date of request: Service #:
Name (first & last):
Contact phone: Contact email:
Customer mailing address:
Street address:
City: State: Zip:
Requested documents:
✔ Service Request Form Copy of Invoice/ Sales Order
Reason for service:
Service technician use only:
Date received: _______________ Date completed: ______________
Light Charger Attachment(s)
Battery Composite Filter Loupes
Other ___________________________________
Warranty: Y N Service total: $ _________
3505 Cadillac Ave. Bldg #H
Costa Mesa, CA 92626
Tel: (323) 316-4514
Fax: (714) 436-5003