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DATALOGIC SCANNING, INC.
RETURN MATERIAL AUTHORIZATION REQUEST
Billing Customer Number (if known):
COMPANY NAME / ADDRESS
(Requesting / Billing Party)
Shipping Customer Number (if different):
COMPANY NAME / ADDRESS
(Ship To Party)
Requestor’s name:
Requestor’s email address:
Additional email notification:
Requestor’s name:
Telephone:
Additional information:
Telephone:
Fax Number:
Other:
Check Contract Type:
Extended WTY
Non- WTY
Quick Replacement (QRP)
Factory WTY
Demo Return
Contract Number:
Payment Method: (check one)
Cash In Advance
PO # (terms established)
Credit Card
COD
No Service Contract Currently Exists:
Please Contact Requestor With Contract Options
Please Do Not Contact Requestor At This Time
Check return freight method for Non-warranty repairs:
UPS Ground 2- DAY
FEDEX 3-DAY OVERNIGHT
Model# or Part # Serial# MFG Date
REQUIRED SCANNER INFORMATION
Reason for return
1
2
3
Service/Warranty
4
5
6
7
8
9
10
Shipping Instructions:
1) Please return equipment in original boxes if possible.
2) Attach a copy of this form as the packing slip.
3) Ship to:
Attn: RMA#
DATALOGIC SCANNING, INC.
959 Terry Street
Eugene, OR 97402-9150
Phone: 800-695-5702 x 8283
Fax: 541-687-7998 3/19/2007 C
Check items being sent in:
Item Quantity
Scanner
Cable(s)
Battery(s)
Base Station(s)
Other (describe)
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Note: All prices shown here are list prices in U.S. dollars. Please check with your local office for all other pricing.
**RoHS (Restriction of Hazardous Substances) Part numbers are compliant for shipment to European Union (EU) countries.
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