RMA Form

CPC RETURN MATERIAL AUTHORIZATION FORM

Customer Contact Information
Company Name:
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone Number:	ext:
Email Address:

Customer Product Information Contact (Technical)
Company Name:
First Name:
Last Name:
Phone Number:	ext:
Email Address:

Product Information
Product Model:
Serial Number:
Description:
Date of Purchase
Discrepancy: Please be detailed

Shipping Information
Company Name:
Attention:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone Number:	ext:
Email Address:

Shipper Information
Company Name:
Contact:
Authorization Code:
Authorized Method:
Phone Number:	ext:
* If preferred shipping information is not provided, CPC will ship via the most economical method. Shipping costs will be added to invoice.
I acknowledge that I have read and understand the RMA instructions and warranty information. By submitting this form, I agree to CPC’s terms and conditions concerning returned products. Shipping Container Required. (There will be an additional charge of $300.00 per crate.) If submitting by fax, please send to (631) 434-7026.