RGA REQUEST FORM

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SUBMISSION DATE:

10/15/2018.  

* REASON FOR RGA REQUEST:
RETURN (RESTOCKING FEES MAY APPLY) WARRANTY

SUBMITTED BY:
* FIRST NAME:
* LAST NAME:
* REP AGENCY NAME:
* REP AGENCY ADDRESS:
* CITY,STATE, AND ZIP:
* PHONE:
* EMAIL:

SITE CONTACT:
* FIRST NAME:
* LAST NAME:
* PHONE:
* EMAIL:

IS REPLACEMENT ORDER NEEDED?:
YES (PLEASE PROVIDE SHIPPING ADDRESS)
NO
SHIPPING ADDRESS:
CITY, STATE, AND ZIP:


RGA #1 DETAILS
* PO#: * PO# DATE:
* PART# 1: * QTY# 1:
* PART# 2: * QTY# 2:
* PART# 3: * QTY# 3:
* PART# 4: * QTY# 4:
* PART# 5: * QTY# 5:

* REASONS (PLEASE CHECK ALL THAT APPLY)
ARRIVED DAMAGED
CANCELLED ORDER
DEFECTIVE AUTOTEST
DEFECTIVE BALLAST/DRIVER
DEFECTIVE BATTERY
DEFECTIVE CHARGER BOARD
DEFECTIVE CIRCUIT BOARD
DEFECTIVE LED STRIP
DEFECTIVE OPTICAL LENS
DEFECTIVE TEST SWITCH
DEFECTIVE TRANSFORMER
DUPLICATE ORDER
JOB CHANGE/PRODUCT NOT NEEDED
PRODUCT ORDERED INCORRECTLY
RECEIVED INCORRECT COLOR
RECEIVED INCORRECT GOODS
RECEIVED INCORRECT QUANTITY
SHIPPED TO INCORRECT LOCATION
SHIPPED PRIOR TO RELEASE DATE
SAMPLES RETURN


* PLEASE PROVIDE A DETAILED EXPLANATION BELOW:



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