RMA Request Form

First Name*

Last Name*

Company*

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Address*

Same as billing

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Enter Email Confirm Your Email

Phone

Model Number*

Serial Number*

Service Required*

If Repair Service is selected above please describe

Additional Model Numbers and Serial Numbers

Calibration Cycle*

Return Shipping*

For return shipment, please provide a UPS or FedEx collect account number. IF you do not have one, TEGAM can prepay and add to the invoice.

Collect Account Number

Method of Payment*