VDC Display Systems: RMA Request Form

Please complete the Return Materials Authorization form below

Your Name:
Company:
Company Address:
Your Title:
Phone:
Fax:
Email Address:

Type of Request:
Please check all that apply
Exchange:
Repair:
Credit:
RMA Request Date:

End User Company:
End User Address:
End User Phone:
End User Contact:
End User Email:

Tech Contact:
Tech Phone:
Ship to Company and Address:
Bill to Company and Address:

Projector Model:
Projector Serial Number:

Replacement PO:
PO Amount:

ModulePart Number:
Module Description:
Defective Module Serial Num:
Failure Description:
Additional Comments:

Module Part Num:
Module Description:
Module Serial Num:
Failure Description:

Module Part Num:
Module Description:
Module Serial Num:
Failure Description:

Module Part Num:
Module Description:
Module Serial Num:
Failure Description:

Module Part Num:
Module Description:
Module Serial Num:
Failure Description:
Final Additional Comments: