Precision Sensors - Return Material Authorization Form

Return Material Authorization Form
NOTE: FAILURE TO SUPPLY THIS INFORMATION WILL RESULT IN THE RETURN OF THE GOODS WITHOUT SERVICE

Required Fields *

Billing Information

  Billing Contact
*

  Company Name
*

  Street Address
*

  Town/Providence
*

  State
*

  Phone Number
*

  Fax Number

  Email Address
*

  Zip Code/Postal Code
*

  Country
*

Shipping Information

Same as Billing Information

  Shipping Contact
*

  Company Name
*

  Street Address
*

  Town/Providence
*

  State
*

  Phone Number
*

  Fax Number

  Email Address
*

  Zip Code/Postal Code
*

  Country
*

Will debit be issued? *
Yes
No

If yes, amount to be debited: *

Will failure analysis be required?
Yes
No

Customer Repair Purchase Order No.
*

QTY*	SERIAL NO(s).*	PS P/N*	CUST. P/N*	REASON FOR RETURN*

HAZARDOUS MEDIA *

Has the returned product been exposed to hazardous or toxic substances? YES NO If the unit has been exposed to any media, Precision Sensors requires a copy (FAX is acceptable) of the pertinent MSDS or written statement certifying that the unit was not exposed to any media covered by a MSDS. This information is required prior to the issuance of an RMA number.

Comments

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