ELECTRONIC REPAIR FORM - fincen uscg 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Repair Firm Name & Address in the designated fields. Ensure all details are accurate for effective communication.
3. Input the Repair Firm Telephone Number to facilitate any follow-up inquiries.
4. Fill in the Owner's Name and provide details about the Item Examined, including Make, Model, and Year Manufactured.
5. Indicate whether there was external damage to the item. If applicable, describe both new and old external damages in the provided sections.
6. Assess if you can determine the cause of any new external damage and provide your insights accordingly.
7. Next, indicate if there was internal damage and detail this in the specified area.
8. Evaluate whether you can ascertain the cause of internal damage and document your findings.
9. Circle your assessment regarding whether shipment caused internal damage based on your expertise.
10. Provide specific reasons for your conclusions about internal damage in the designated section.
11. State your experience as a repair technician, including years of experience and areas of expertise.
12. Estimate costs for repairing internal damage, detailing parts, cleaning services, tax, labor, and total costs clearly.
13. List any unnecessary servicing charges that do not affect functionality but may be included as maintenance costs.
14. If applicable, outline charges for repairing any new external damage along with total costs for these repairs.
15. Indicate whether you will deduct your estimate fee from the total bill if assigned to repair this appliance.
16. Print your name clearly in the provided field before signing and dating the form at the end.

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