Repairs Start Here Cozzia’s in house Technical Department supports :Cozzia, Svago, Ergotec, JPMedic, Ogawa, and Fujimedic. forme française 1. Who Is Submitting This Form? Who is Submitting this form? (required) End UserTechnician - For End UserStore - for End UserStore - Floor Model 2. End User Contact Information Full Name (required) Email (required) Phone Number (required) Address (required) 3. Purchase Details Attach Purchase Receipt (must include date) (required) (5 MB Limit) Serial Number (required) Date Purchased (required) Store Purchased at (required) Chair Model Number (required) Chair Color (required) 4. Chair Issue Description Detailed Description / Error Code (required) 5. Upload Photos of the Issue (Optional) Include up to 3 photos showing the problem if applicable. (5 MB per file limit) Picture 1 (optional) Picture 2 (optional) Picture 3 (optional)
