RETURN MATERIAL REQUEST FORM
CUSTOMER COMPANY NAME
:
CUSTOMER CONTACT NAME:
CONTACT'S EMAIL ADDRESS:
CONTACT'S PHONE NUMBER:
EMAIL INVOICE TO:
RETURN PRODUCT TO:
RETURN ADDRESS 1:
RETURN ADDRESS 2:
CITY:
STATE:
POSTAL CODE:
COUNTRY:
RETURN TO THE ATTENTION OF:
YOUR PO #:
YOUR WO #:
PRODUCTS TO BE REPAIRED
PRODUCT TO REPAIR:
UNIT SERIAL NUMBER:
PRODUCT TO REPAIR:
UNIT SERIAL NUMBER:
PRODUCT TO REPAIR:
UNIT SERIAL NUMBER:
PRODUCT TO REPAIR:
UNIT SERIAL NUMBER:
PLEASE LIST ADDITIONAL UNITS IN THE ADDITIONAL COMMENTS FIELD BELOW
REASON FOR RETURN
PLEASE DESCRIBE THE PROBLEMS AND FAILURE SYMPTOMS AND ANY STEPS
REQUIRED TO REPRODUCE THE FAILURES
ADDITIONAL COMMENTS
REPAIR SERVICE - STANDARD OR EXPEDITED
STANDARD REPAIR SERVICE (3-4 WEEKS)*
EXPEDITED REPAIR SERCICE (5 BUSINESS DAYS)**
* REPAIR SERVICE TIME AFTER RECEIPT OF PRODUCT
** EXPEDITED SERVICE IS AN ADDITIONAL $80.00 CHARGE
RETURN SHIPPING SERVICE - PLEASE SELECT
SELECT
SERVICE:
UPS Ground
UPS 3-Day Select
UPS 2nd Day Air
UPS Next Day Air
UPS World Wide Saver (1-3 business days)
UPS World Wide Expedited (2-5 business days)
FedEx Ground
FedEx 3-Day
FedEx 2-Day
FedEx Next Business Day
DHL (international only)
Other (please explain below)
SHIPPING
NOTES:
ADD RETURN SHIPPING CHARGES TO MY REPAIR BILL
CHARGE SHIPPING TO MY CARRIER ACOUNT
CARRIER NAME AND YOUR ACCOUNT NUMBER
