Please fill out the Request Material Authorization as completely as possible.
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RMA TypeRepairRE-CertificationCreditWarranty Claim

Contact Person

Name *

Email *

Phone Number *

Fax Number

Ship to Address

Ship to Company Name *

Street Address *

Street Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Bill to Address

Same as Shipping AddressYes

Bill to Company Name

Street Address

Street Line 2

City

State / Province / Region

Postal / Zip Code

Country

Return Shipping Information

Carrier Name *Please specify with your carrier information if you do not want us to determine the shipping.

Shipping Account # *Please specify with your carrier account number if you do not want Pre Pay and Add..

Returned Model And Part Information

Number Of Models Returning

Model/Part 1 Information

Model Number 1 *

Quantity *

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 2 Information

Model Number 2

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 3 Information

Model Number 3 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 4 Information

Model Number 4 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 5 Information

Model Number 5 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 6 Information

Model Number 6 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 7 Information

Model Number 7 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 8 Information

Model Number 8 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 9 Information

Model Number 9 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

Model/Part 10 Information

Model Number 10 *

Quantity

Description *

Serial Number(s) *

Date Purchased

Date Shipped

Date Last Repaired

General Information

Reason for Return / Problem Description *

Additional Information / Special Instructions

Is the product a battery magnetNoYes

I understand that I cannot ship a battery with the magnet returned *Yes

I understand that All Oil Cooled Electro Magnets, must be fully drained of oil prior to any shipment. *Yes

Authorization and Submission (Required)

Please read our Terms and Conditions completely and carefully before submitting this form. By submitting your form, you are agreeing to our Terms and Conditions

Quotations are valid for 30 calendar days after submission. If a disposition has not been received after 30 calendar days from quotation, we reserve the right to return the equipment at the customer’s expense. Minimum Inspection fees may apply.

Accept-Terms *Yes, I agree with the terms and conditions

Request Material Authorization (RMA)Product Literature

Contact Person

Ship to Address

Bill to Address

Return Shipping Information

Returned Model And Part Information

Model/Part 1 Information

Model/Part 2 Information

Model/Part 3 Information

Model/Part 4 Information

Model/Part 5 Information

Model/Part 6 Information

Model/Part 7 Information

Model/Part 8 Information

Model/Part 9 Information

Model/Part 10 Information

General Information

Authorization and Submission (Required)

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Contact Information