Equipment Return Material Authorization Form

RMA FORM FOR EQUIPMENT

Equipment Return Material Authorization Form.

Please fill out the form completely. Upon completion and approval by DILO, an RMA number will be issued. Please do not ship any equipment prior to obtaining an RMA number. A physical copy of the RMA form must accompany your equipment during shipping.

Company Name*

Estimate Contact Name*

Email*

Phone number*

Shipping Information

Shipping Contact Name*

Street*

City*

State/Province*

Zip Code*

Country*

Shipping Phone Number*

Shipping Email*

Carrier*

Other carrier

Speed*

Next Day Air

2nd Day Air

Ground

Other

Collect Number

Other speed

Please note that 3-038 & 3-038R series analyzers will be shipped via LTL carrier – NO EXCEPTIONS

Billing Information

Payment Method (select one)*

Credit Card

Invoice

PO Number (if PO)

Invoice to (if invoice)

Return Material Detail

Choose one*

Analyzer

Recovery system

Other

Model Number*

Serial Number*

Order Number

Description of Problem/Desired Action*

Are you interested in trading-in your system for the latest model version?*

Yes

Will you be sending in the accessory adapter kit with the device?*

Yes

Please quote a replacement accessory kit

If available, are you interested in a rental unit for the service downtime?*

Yes

If DILO Direct connect is available for your system, would you like to renew the service plan?*

Yes

Do you have used gas cylinders DILO can help recondition or dispose of for you?*

Yes

Contamination Disclosure

For the safety of our technicians please answer all questions in this section accurately:

Has the device been filled with gases other than SF6 ?*

Yes

If yes, please list the gasses

Does the device contain any SF 6 decomposition products?*

Yes

I acknowledge that I have read and agree to DILO’s Terms of Conditions (see link below):*

Yes

Comments/Concerns to DILO's T&C's:

After the device is received by DILO, a cost estimate will be sent to the “Estimate Contact” listed in this form. Please respond within 30 days of estimation to avoid storage fees.

Terms and Conditions