Kansas Hearing Aid Repair form: type or write in information. Print it and  Mail repair form  with hearing aid.
Name:
Date:
Address:
Phone#
City:
Work/Cell#
State
or Country
Zip Code:
Brand of hearing aid(s)or #:
Problem with hearing aid(s):
Right
Left
Both
Dead
Weak
Static
Shell
Distorted
Door
Intermitting
Other
Repair services with warranty. Priced per hearing aid. Click to Check box
Economy Service
3 months Warranty
$120
Standard
6 Months Warranty
$130
Premium
1 Year Warranty
$150
48hr rush order---$15
New shell or copy (clone) or new circuitry call for price.
Batteries: Premium batteries 40 per box. $20 each box.
Size
10 yellow
312 brown
13 orange
675 blue
Shipping Methods: Click on drop box
Payment with order: Check,Visa/Master Credit or Debit Card
Money Order or call for payment
Insurance: Click on drop box
Credit Card #
Expiration Date:
CVV# ( Last the three digit on the back)
CVV#
To find the CVV# click here.
Address for credit card statement if different from address or  more Information.
Kansas Hearing Aid Repair
814 E Main St #155
Gardner KS 66030
1-800-976-0601
www.kansashearingaidrepair.com
Only Kansas residents tax will be add
Shiping to Canada $11 first class only