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RMA Request Form

Please fill out RMA form below, and click on submit once finished.

RMA Request From
Company Name*
Contact Name*
Phone Number*
Fax Number*
E-Mail*
Sales rep. Email
RMA Information
PO #
Invoice#*
Part Number*
Qty*
Unit Cost*
Date of part received*
Did the part fail against the Manufacturer specfication?	Yes No
Is there any third party failure report attached?	Yes No
Reason for Return*
Explanation*
	Signature:(Just write your name)

	This Request must be submitted within 10 Days of receipt of parts This Request must be accompanied by a legitimate independent test report confirming the defect Parts will be subject to inspection before credit is considered See complete Terms and Conditions on the opposite side of the Invoice Conditional returns will not be accepted without an RMA and goods returned without an RMA will be sent back to Buyer at Buyer's cost.

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