RMA Form

CPC RETURN MATERIAL AUTHORIZATION FORM

Customer Contact Information

Company Name *

First Name

Last Name

Address 1

Address 2

City

State

Zip

Phone Number

Email Address

Customer Product Information: Technical Contact

Company Name *

First Name

Last Name

Phone Number

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

Shipping Phone

Shipping Email

Shipper Information

Company Name

Contact

Authorization Code

Authorized Method

Shipper Phone

Note: If preferred shipping information is not provided, CPC will ship via the most economical method. Shipping costs will be added to invoice.

If submitting by fax, please send to (631) 434-7026.

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