Return Material Authorization

All Fields marked with asterisk(*) are required

Billing Address

First Name *

Last Name *

Company *

Address *

City *

State/Province

Country *

Zip *

Phone *

Email *

Fax *

Leave blank if same as billing information
Shipping Address

First Name

Last Name

Company

Address

City

State/Province

Country

Zip

Phone

Fax

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:

Item 1 - Type *

Part Number *

Quantity *

Item 2 - Type

Part Number

Quantity

Item 3 - Type

Part Number

Quantity

Item 4 - Type

Part Number

Quantity

New P.O. Number

Failure Analysis and/or Corrective Action Required *

None
Failure Analysis Required Only
Corrective Action Required Only
Both Required

Add an attachment for your Corrective Actions specified format:

Industry

Returned By *

Ship Via *

Comments/Question *

Reason for Return *

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