Customer Details – Please Provide Information Requested Below And FAX To 714 992 0471 Obtain RMA# RMA Request Form

User Manual: RMA Request Form

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DownloadCustomer Details – Please Provide Information Requested Below And FAX To 714-992-0471 Obtain RMA# RMA Request Form
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Anaheim Automation, Inc.
Return Materials Authorization (RMA) Request Form

Customer Details

www.anaheimautomation.com
714-992-6990 714-992-0471, Fax
– Please provide information requested below and FAX to 714-992-0471 to obtain RMA#

Return to Company:

Contact Name:

Ship To Address:

Phone Number

City/Sate/Zip:

Fax Number:

ATTN:

Email:
Check all that apply:

Date RMA
Requested:

___Typical Turnaround, 10 days
___Review Possible Substitutions
___Quote “Spare Part”

Requested By:
Purchase Order:
(optional)

Billing Information:
(if different from
Ship To address)
Billing
Contact:

Terms: FOB is Anaheim, California, shipped uninsured unless
specified “Insured” and accept additional fees

Payment: Choose payment options from below

_____Net 30 Days, Established Accounts
_____COD
Credit Card – MasterCard, VISA, Discover and American Express accepted
Card
Number:____________________________________________________
Name
On Card:____________________________________________________
Expiration
Zip Code
Date:____________________
on Card:______________________

California Customers: ____Taxable, as applicable

Phone:

Shipping Method: The default shipping method is UPS ground service,
prepaid and added to the invoice, unless specified below
UPS: _____1 day

_____2 day _____ 3 day

UPS Collect Account #_________________________________________
(optional)
FedEx: _____1 day

_____2 day _____ 3 day

FedEx Collect Account #_______________________________________
(optional)

____Resale: Resale Certificate on file: ____yes

____no, please send forms

Return/Repair Information – Please provide all information requested below, so that we might better serve you!
Model Number
One item per Line

Date
Code

Serial
Number

Reason for Return
Please indicate RETURN or REPAIR

Original
Invoice

Estimated
Flat Rate Fee

Customers are notified of the RMA # and any cost by fax or email, within 48 hours - Do not use a Debit Memo
Use extreme care in packing returns - Anaheim Automation is not responsible for damages during transit

For internal use only – Customers do not supply information below
RMA#

Restocking Fee:
(if applicable)
$
Date RMA
Rec’d:
RMA
Rec’d. By:

RMA #
Issued By:
Date RMA#
Issued:
(valid 30 days)
Action
Taken: ____Repaired and Returned
____Replacement sent, Date Shipped:_____________

Print Form
Print
Form

Credit
Amount: $
Credit
Issued By:
Reason for
Credit:
____Returned to AA Stock, Issued Credit

Submit by Email

Important Notes: Anaheim Automation keeps RMA numbers active for 30 days after the RMA request date. After 30 days, the RMA will be
deleted from our records. Any product not returned to Anaheim Automation within 30 days, will require a new RMA#. Product returned without
an RMA# will NOT be processed. Typical repairs will take 10 business days. Motors and gearboxes may take up to 45 days. Anaheim Automation
charges a “flat-rate” repair fee for products not covered under warranty, regardless of the problem found. CREDIT for returns will be solely
determined by Anaheim Automation, following inspection and test. The restocking charge is 15% on all products returned. The minimum restocking charge
is $25.00. Shipping expenses are paid by the customer. Anaheim Automation is not responsible for damages during transit.
Ship Returns/Repairs to: Anaheim Automation Inc., 910 East Orangefair Lane, Anaheim, CA 92801.
Clearly m ark each carton w ith the assigned RM A num ber.
Thank You.
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Title                           : Customer Details – Please provide information requested below and FAX to 714-992-0471 to obtain RMA#
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