Online Return Authorization Form

To expedite our Return Authorization service, please fill out the below form and click to ‘Submit’. The fields marked by an asterisk ( * ) are mandatory.

After you click 'Submit', you will receive your RA number . The RA Number must appear on all related correspondence, shipping papers, and invoices.

Kindly read our Terms and Conditions of Sale.

Company Name:
*Customer Contact:
*Billing Address:
*City :
*State/Province :
*Zip:
*Phone:
*Customer E-mail :
Fax:

Buyer:

Original PO#

Original SO#

Replacement SO#

*ORIGINAL INVOICE TERMS:

*REFUND CREDIT TO BE MADE VIA:

You must enter at least on item.

* ITEM #	* DESCRIPTION	Opened	* REASON FOR RETURN	* QTY	* UNIT PRICE	*TOTAL
						*
*	*			*	*	*
*	*		*	*	*	*
*	*		*	*	*	*
*	*		*	*	*	*
*	*		*	*	*	*
*	*		*	*	*	*
*	*		*	*	*	*
*	*		*	*	*	*
*	*		*	*	*	*

*Salesperson

*Return to Vendor for Credit ?

*Location/Office

Comment :