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Request Form

Use this form to begin the evaluation process before purchasing a Parastream Vintage BX-3/CX-3 Repair Service kit. Depending on your skill level and/or the symptoms of the instrument, we may recommend you not purchase the repair kit and instead take it to a local repair shop and tell the shop manager about the availability of this repair service.

Please describe yourself:

	The instrument owner who likes for someone else to turn the organ on.
	The instrument owner who is comfortable using a screwdriver and following detailed instructions.
	A repair shop who otherwise couldn't repair the instrument due to lack of parts availability.

Please describe the organ's symptoms:

Tell us how to get in touch with you:

You only have to fill out the fields that pertain to the ways you would like to be contacted.

Please consider using phone or fax numbers in addition to email, especially if you are located outside the United States. We have experienced problems with email getting through due to spam blockers or other problems, although it is rare.

Name:
Address:

City:
State/province:
Zip/postal code:
Country/region:
E-mail:
Phone:
Fax:

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