M&J 360 Repair form

**Please print a copy of this form and include with your console when you ship it in.**

Ship console only to:
M&J 360
1185 Telegraph Rd.
Gretna, VA 24557

Name First* Last*
Address
Street Address*

Address Line 2

City*

State / Province / Region*

Postal / Zip Code*

Country
Email*
Phone - (###) - ### ####
Xbox Serial Number* (Found on the back of console)
Select the Problem with your Xbox RRoD (1, 2,3, or 4 red lights) E64,E65,E71,E73,E74, Errors Overheating, hot to the touch Garbled video, distortion NO Audio or Video, green lights NO power at all(Doesn't include power brink with red light) When inserting game it says "Insert xbox game into console" DvD drive sticking DvD drive says "open tray" DvD does not open or respond
Additional Information: