First Name                 Last Name   

Company (if applicable)

Return Information

Address Line 1

Address Line 2

Address Line 3

City    State    Zip code (Postal Code)   

Country

Daytime Phone    Alternate Phone

eMail Address

If paying with a Visa or MasterCard, Card Number _________________________________  

Note Credit Card Number is not sent with this form.  If mailing, print out this form and handwrite the number.  You can also call, email or fax us.

Expiration (MM/YY) CCV2 (security code on back)   Visa Master Card

Camera Make and Model

Conversion Type    IR-Only 715nm    IR-Only 830nm     UV+Visible+IR    

                            IR-Only 665nm    IR-Only 590nm    High Resolution (HR)

                            UV-Only             H-Alpha Astronomy 

Any special notes 

When sending camera in, please make sure to:

    Carefully package camera with body cap  Please remove any camera straps and tripod mounts.

    Include a charged battery for testing

    Insure camera for replacement cost

    Include copy of this form or cover letter with the same information

    Include payment information (Visa, MasterCard, Check, Money Order, cash) or we can call for credit card information after completion

    Make sure the requested camera conversion is one we support

    If sending camera from outside of USA, make sure to indentify camera as being sent for "REPAIR".  Otherwise we may get charged an import tax, and we will re-bill you.

Modification Notes:

The most common IR-Only modification is 715nm.

Please check with us to make sure we can perform the conversion you would like before sending in the camera.

Modifications usually take 1 or 2 working days from receipt.  If camera is needed urgently, please let us know.

Most DSLR conversions (with the exception of monochrome conversions) are $450 + return S&H of $20 UPS Ground for continental USA.  If you live outside the USA or need expedited shipping, the cost will be higher.

Please ship camera following the above instructions to:

Please contact us at sales@maxmax.com or (001) 201-882-0344 between 8:00AM and 4:00PM EST for any questions.

If you would like us to keep a record of your request on file, please click on the Submit button.  If you do not press Submit, nothing will be saved.