Monthly Device Protection Registration

First Name *

Last Name *

Email Address *

Phone *

Address 1 *

Address 2

City *

State *

Zip *

Device information

Model of device *

Device Color *

Storage Size *

Carrier *

IMEI or Serial Number *

MUST BE A CLEAR PHOTO AND SHOW DEVICE SCREEN WORKING AND BE ON THE SETTINGS PAGE SHOWING THE IMEI/SERIAL NUMBER OR PLAN WILL BE REJECTED. ANDROID - THE NUMBER IS FOUND IN SETTINGS > ABOUT DEVICE > STATUS. TAKE THE PHOTO ON THIS SCREEN! IOS - OPEN SETTINGS. TAP GENERAL > ABOUT. SCROLL DOWN TO LOCATE THE IMEI NUMBER. TAKE THE PHOTO ON THIS SCREEN! *

Current issues not covered

INDICATE CURRENT ISSUES WITH DEVICE THAT AREN'T COVERED BY CHECKING THE BOX(ES) BELOW. THESE ARE ITEMS THAT WILL NOT BE CONSIDERED FOR REPAIR ON FUTURE CLAIMS.

Payment info

Store Visited *

Lynchburg

Bedford

Cave Spring

Online

BY SIGNING, I AGREE TO BE DEBITED $5 PER MONTH ON MY CREDIT CARD, UNTIL CANCELED, FOR MY DEVICE TO BE ON THE PHONEAXIOM EXPRESS DEVICE REPAIR PROTECTION PLAN. I UNDERSTAND THAT I CAN CANCEL AT ANY TIME BY CALLING PHONEAXIOM EXPRESS DEVICE REPAIR OR STOPPING BY A STORE. (NO REFUNDS WILL BE ISSUED) - I UNDERSTAND THAT THERE IS A $50 CLAIM FEE DUE UPON PICKUP OF THE DEVICE AFTER COMPLETION OF A REPAIR THROUGH THE CLAIMS PROCESS. I FURTHER UNDERSTAND THAT THERE IS A $500 LIMIT OF LIABILITY PER YEAR FOR REPAIR AND/OR REPLACEMENT COSTS FROM DAMAGE TO MY DEVICE THAT IS COVERED. IF FOR ANY REASON PAYMENT IS DECLINED, COVERAGE MAY BE CANCELED WITHOUT NOTICE. THIS IS NOT AN INSURANCE PLAN, BUT A PROTECTION PLAN MEMBERSHIP. *

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Plan Cost *

Monthly Protection Plan ($5/mo/$50 Deductible/$500/yr limit)

LCD Display Screen Cracked	Digitizer	Glass Damage	Home Button
Proximity Sensor	Front Camera	Rear Camera	Headphone Port
Charging Port	Flash	Earpiece Speaker	Loudspeaker
Power Button	Light Sensor	Main Microphone	Speakerphone Microphone
Volume Up Button	Volume Down Button	WIFI Radio	Bluetooth Radio
Cellular Radio	Fingerprint Sensor	Force Touch Panel	Bottom Soft Buttons
Vibrate/Ringer Switch	Scratches on Device Scratches on Device