Fields marked with an asterisks are required fields.
Billing Information

*Bill To Name:
*Address Line 1:
Address Line 2:
*City Name:
*State Name:
*Zip Code:
Shipping Information
Same as Billing?:
*Ship To Name:
*Address Line 1:
Address Line 2:
*City Name:
*State Name:
*Zip Code:
Additional Contact Information
*Contact Name:
*Phone:
Fax:
E-mail:
Additional RMA Information
*PO Number:
*Model Returned:
*Date Codes:
*Quantity:
*Reported Failure

-- Payment terms are net 30. We do not accept credit cards.

-- Please do not send modules without first obtaining an RMA number.

-- We will reply to the e-mail address if given or call the contact phone number with an RMA number, price, and shipping instructions.

Complete Form To Submit
Submit RMA Request