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Cost of Repair or <br /> Replacement (state <br /> whether repaired or re- <br /> Brand and Initial Placed, and cost of re- <br /> pair or replacement. <br /> Model No. Year Purchase Also attach receipt if <br /> Item(s) Damaged (if avail- Purchased Price available, dated between <br /> able) 7-01-97 and 10-31-97) . <br /> 7 . <br /> 8 . <br /> 9. <br /> 0. <br /> 11 . <br /> 12 . <br /> 13 . <br /> • <br /> Attach Additional Sheets if Necessary <br />