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Request for Return Material Authorization (RMA) Number
Company
Customer No.
Customer Name
City
Postal code
Contact
First name
Last name
Email
*
Phone number
Fax number
Reason for Return
Return Reason
Return for credit
Repair/ Evaluation
Return for Exchange
What does the return shipment pertain to?
Order No.
Order Information
PO Number
Date
Month
/
Day
/
Year
Additional Information
Device Information
Include serial number and quantity
Error Description
Describe the error in as much detail as possible
RMA Attachment
Upload pictures or other supporting documents here
Ticket name
*
Ticket description
*
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