RA Request Form

This form must be COMPLETED and SENT with all RETURNS

Returns Fax Number: 717-361-5801

You will be notified in 2 to 3 businss days with an RA number.
There will be a 15% restocking fee for new merchandise returned without prior approval
Any merchandise returned defective, that is not defective will be returned to you.
Items must be complete, in the original box or packaging and must include all accessories.
LCD screens are inspected for damage, lines and scratches upon arrival. Damaged screens are not accepted as manufacturer defects.

Company Name *

Account # *

Purchase Order #

Your Name *

Your Email Address *

Phone Number *

Fax #

Your Sales Representative

RA #

REPLACEMENT SHIP TO ADDRESS: (Only Use if Different than Your Default Address)

Company Name

C/O Name

Street Address

Address Line 2

City

State

Zip Code

(Please give a specific answer other than "DEFECTIVE" for the "Reason for Return".)

Qty *

Product # *

Reason for Return *

Requested Action *

Qty

Product #

Reason for Return

Requested Action

Qty

Product #

Reason for Return

Requested Action

Qty

Product #

Reason for Return

Requested Action

Qty

Product #

Reason for Return

Requested Action

Qty

Product #

Reason for Return

Requested Action

Qty

Product #

Reason for Return

Requested Action

Qty

Product #

Reason for Return

Requested Action