Contract RMA Maintenance Request Form

The information you are providing below is strictly confidential and will not be sold or redistributed without your authorization.If you have any questions please call Barcode4Less at 847-984-0097
.

RMA Information
Repair Type : Date:
Existing Customer :

Customer Number :
If this equipment was repaired by Barcode4Less within 90days then select YES, otherwise if unsure select NO.
Under Warranty :

Billing Information
First Name: *
Last Name: *
E-Mail: * A RMA confirmation will be send to this e-mail address.
Company: * * denotes required fields
Address: *
City: *
State: *   Zip: *
Phone: *   Ext:
Fax: *
Shipping Information (Check to use Billing Information: )
First Name:
Last Name:
E-Mail:
Company:
Address:
 
City:
State:   Zip:
Phone:   Ext:
Fax:
•Equipment Information•
Manufacturer: Model: S/N : Problem Description :
 
 
   
   
   
   
•Additional Billing and Shipping Information•
Payment Method: For abused/damaged equipment only.
 
Do you wish to add an expedite fee of $35.00 per each repair for faster turn-around (1 day turn around)
     Yes, expedite my repair for an additional $35.00
     No, don't expedite my repair for an additional $35.00
Return Shipping method: Contract Customers will be billed for additional shipping charges above and beyond Ground service.
Comments:
To pay using credit card please see payment policy
Items with asterisks represent required inputs. If you have any questions please call Barcode4Less main office at 847-984-0097
.



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