Return Material Authorization

All Fields marked with asterisk(*) are required

Billing Address

First Name *

Field cannot be blank. Please enter only alphabets.

Last Name *

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Company *

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Address *

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City *

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State/Province

Country *

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Zip *

Field cannot be blank. Invalid Zip format.

Phone *

Field cannot be blank. Please enter 8-25 digits.

Email *

Field cannot be blank. Invalid Email.

Fax *

Field cannot be blank. Please enter digits from 8 to 25

Leave blank if same as billing information
Shipping Address

First Name

Please enter only alphabets.

Last Name

Please enter only alphabets.

Company

Please enter only alphanumerics.

Address

City

Please enter only alphabets.

State/Province

Country

Zip

Invalid Zip format.

Phone

Please enter 8-25 digits.

Invalid Email.

Fax

Please enter digits from 8 to 25

Returned Part Information If more that 4 types of parts need to be returned, please attach a spreadsheet or document with the Part Number, Quantity and any other pertinent information below.

Attachment of returned details for more than 4 types of parts:

Invalid file name.

Item 1 - Type *

Please enter only alphanumerics. Field cannot be blank.

Part Number *

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Quantity *

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Item 2 - Type

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Part Number

Quantity

Please enter only digits.

Item 3 - Type

Please enter only alphanumerics.

Part Number

Quantity

Please enter only digits.

Item 4 - Type

Part Number

Quantity

Please enter only digits.

New P.O. Number

Failure Analysis and/or Corrective Action Required *

None

Failure Analysis Required Only

Corrective Action Required Only

Both Required

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Add an attachment for your Corrective Actions specified format:

Invalid file name.

Industry

Returned By *

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Ship Via *

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Comments/Question *

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Reason for Return *

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