2012 Falcon® Electric Inc. All rights reserved. All other brand names and trademarks are the property of their respective owners. The information stated in this document is subject to change without notice. Falcon®, Falcon® Electric and UPS logos are registered trademarks of Falcon Electric, Inc. 12-18-2012

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RMA REQUEST FORM (TO ACCELERATE PROCESSING, PLEASE COMPLETE ALL APPLICABLE FIELDS)

Company Name: Ship to Address:

Contact:

Phone: Ext.:

Email:

ITEM DESCRIPTION

Model Number: Serial #:

Problem or Symptom:

Model Number: Serial #:

Problem or Symptom:

Model Number: Serial #:

Problem or Symptom:

Model Number: Serial #:

Problem or Symptom:

PAYMENT METHOD (REQUIRED FOR ALL RETURNING ITEMS)

Credit Card #: Purchase Order #:

Card Type (Circle One) Amex MC Visa Expiration: Code:

Billing Contact Information: (If Different) Bill To Address: (If Different)

RETURN SHIPMENT METHOD IF INFORMATION BELOW IS NOT PROVIDED, FALCON ELECTRIC WILL PREPAY & ADD (PP & A) RETURNED

MATERIALS. SHIPMENTS OVER 60LBS MUST BE SHIPPED USING FREIGHT LTL SERVICES.

Carrier Account #: Return Shipment Service:

THE SECTIONS BELOW ARE FOR INTERNAL USE ONLY

RMA Info: Original Order Details: RMA Type

RMA Assigned: Ship Date: Warranty Non Warranty

Assigned By: Sales Order: Return to Stock / Credit Return for Exchange

Approved By: Invoice: Extended Warranty 1yr 2yr 3yr