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California Prison Industry

Dispenser Repair or Replacement Request Form

Last updated: November 25, 2024

CALPIA stands behind its quality products.

Please enter your customer information and a description of the repairs needed.

Dispenser Type

left to right: Four Button Metal Dispenser, Single Button Metal Dispenser, and Plastic Dispenser

Dispenser Repair or Replacement Request Form

First Name

Last Name

Organization

Address

City

State

Zip Code

Daytime Phone Number

Ext.

Cell Phone Number

Email

Alternate Contact Name

Alternate Phone Number

Alternate Email

Sales Order Number

Products to be Repaired

Four-Button Metal Quantity

Single-Button Metal Quantity

Plastic Quantity

Repair Description

Repair Location

Comments

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