RMA Request Form

First name*

Last name*

Company name*

Phone number*

Email*

Ship to Address

Street address*

Address Line 2*

City*

State/Region*

Postal code*

Country/Region*

Ship to Company Name*

Replacement or Repair?*

Replacement

Repair

Order Information

Original Job or PO Number*

Part Number 1*

Quantity of Issue Product Number 1

Part Number 2*

Quantity of Issue Product Number 2

Part Number 3*

Quantity of Issue Product Number 3

Install Information

Installer Name*

Installation Date*

Month/Day/Year

Date of Issue*

Month/Day/Year

Size of Circuit Breaker*

Voltage Input*

Voltage Measured at Fixture Location

Hours in Operation

Ambient Temperature

Surge Protection Installed*

Yes

Enviroment*

Indoor

Outdoor

Wet Location*

Yes

Description of Issue*

Are there additional components connected to the fixture, i.e. emergency backup?*

Description of Application

Terms and Conditions for Shipment of Product Before RMA Approval.

1) I approve shipment of the replacement product(s) listed on this RMA request at my own expense by accepting these terms and conditions.

2) If a GenPro Advanced Technologies Engineer determines the RMA is not warrantied, I acknowledge I will be billed for the purchase price of the product(s) replacement(s) by GenPro Advanced Technologies.

3) I acknowledge a purchase order must be sent to GenPro Advanced Technologies for the shipment of the RMA request. Pricing will be determined by GenPro Advanced Technologies.

4) I will ship the product(s) not working at my own expense to GenPro Advanced Technologies for approval of this RMA. If the RMA is approved, GenPro Advanced Technologies will ship the replacement product back to the customer at GenPro Advanced Technologies expense.

Ship to:

GenPro Advanced Technologies, LLC

13261 Timberline Plaza, Suite A

Piedmont, South Dakota 57769

605-719-7022

email: shipping@genprotech.com

Attn: Bhavin Sampat

** GENPRO ADVANCED TECHNOLOGIES will not issue an RMA or accept any returned product unless the Customer’s account is in good standing. **

I accept the Terms and Conditions *

Photo Attachments

Signature

SignatureDate

Month/Day/Year