Media Replacement Request

Use this form if you receive defective media or if you do not receive media by the time you normally receive it.

Do not request replacement for missing media until the normal delivery time has passed or you have already checked your internal mail department (if applicable).

There is no charge for the replacement of defective or missing media.

Return the defective media to CAETE marked with the specific problem. (CAETE, University of Colorado, Engineering Center, Regent Dr. and Colorado Ave., ECCR 1B43, Boulder, CO 80309-0435)

Your Contact Information

Student Name: *

Student ID (last 4 digits): *

Phone: *

EO Information (if media are shipped to an EO)

EO Name:

Company:

Course Information

Course Number(s): *

Course Title(s): *

Air Date(s): *

Lecture or Session Number(s): *

Reason for Request

Reason : *

Missing

Damaged by carrier

Defective (please describe below)

Other (please describe below)

Description:

Delivery Method

How would you like us to deliver the media to you?: *

Pick-up at CAETE

UPS

FedEX

1st Class Mail

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