RGA Request Form

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Submission Date:

11/19/2017.  

* Reason for RGA request:
RETURN (restocking fees may apply) WARRANTY

* SUBMITTED BY:
* REP AGENCY NAME:
* REP AGENCY ADDRESS:
* City and State and Zip:
* PHONE:
* EMAIL:


RGA #1 DETAILS
* PO#: * PO# DATE:
* PART# 1: * QTY# 1:
* PART# 2: * QTY# 2:
* PART# 3: * QTY# 3:
* REASONS (please check all that apply)
RECEIVED INCORRECT MATERIALS RECEIVED INCORRECT QUANTITY SHIPPED TO INCORRECT LOCATION
JOB CHANGE/PRODUCT NOT NEEDED ARRIVED DAMAGED PRODUCT ORDERED INCORRECTLY
DOUBLE SHIPMENT CANCELLED ORDER SHIPPED PRIOR TO RELEASE DATE
DEFECTIVE    
Please provide detailed explanation below:



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