1130 Stuart Drive, Merced, CA 95341
P: (209) 722-4145 F: (209) 349-8934
www.lairdmfg.com

RMA Form

SECTION 1

Customer Name:

Date: Customer RMA No:

Invoice Ship to Address:

Contact Name: Contact Phone:

Email Address:

OTHER INFORMATION

CustomerLaird

Purchase Order No:

Your Part No:

Order No:

Invoice No:

PRODUCT INFORMATION

Laird Part No: Quantity:

Description:

LAIRD Model/Serial No:

REASON FOR RETURN

RMA No - LAIRD USE ONLY

On receipt of the LAIRD RMA NUMBER please promptly return the product and any packaging materials securely packed and carriage FOB to LAIRD for examination.

LAIRD will investigate your return and will report any conclusions made as soon as possible bearing in mind the product may have to be returned to a manufacturer's facility for failure analysis in the Far East. Should the failure be attributed to customer error LAIRD reserves the right to re-invoice the product, charge for any repair requested and charge for any carriage cost.

LAIRD Standard Terms & Conditions apply.

SECTION 2 (Part 1) - For LAIRD Use Only

Approved: Authorized: Date:

**Please note that this RMA will expire 30 days after the issue date. If the items on this RMA are not returned within the said 30 day period this RMA will automatically be canceled and you will need to resubmit your request for RMA.

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