TiVo Exchange Form

Please complete and submit this form along with your return package. NOTE: Packages that are lost or damaged in transit are the responsibility of the shipper. We recommend, for your own protection, that you insure your package and send it via a trackable method. Please be sure to record any tracking number used for future reference.

1. Please write your Exchange number in the space below. This number should have been given to you by a Customer Support Representative when your TiVo product was approved for exchange. Without a valid exchange number, your package will not be accepted. NOTE: Please write your Exchange Number on the outside of the box in which you are shipping your exchange.
   
   Exchange #: _____________________________________________________
2. Address:
   
   First Name _____________________ Last Name _______________________
   
   Address 1 ______________________________________________________________
   
   Address 2 ______________________________________________________________ City __________________________ State ________ Zip ________________

3. Your phone number: _______ - _______ - ______________
4. Model Number: ____________
5. (DVR Only) 15 Digit TiVo Service #: ______________________________________________

I hereby agree to the Exchange Process as set out on the web pages www.tivo.com/exchange/ and the associated charges for the exchange of the product.

Signature _____________________________________________ Date _______________