RGA REQUEST FORM
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SUBMISSION DATE:
04/24/2024.
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REASON FOR RGA REQUEST:
RETURN (RESTOCKING FEES MAY APPLY)
WARRANTY
SUBMITTED BY:
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FIRST NAME:
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LAST NAME:
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REP AGENCY NAME:
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REP AGENCY ADDRESS:
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CITY,STATE, AND ZIP:
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PHONE:
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EMAIL:
SITE CONTACT:
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FIRST NAME:
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LAST NAME:
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PHONE:
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EMAIL:
IS REPLACEMENT ORDER NEEDED?:
YES (PLEASE PROVIDE SHIPPING ADDRESS)
NO
SHIPPING ADDRESS:
CITY, STATE, AND ZIP:
RGA #1 DETAILS
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PO#:
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PO# DATE:
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PART# 1:
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QTY# 1:
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PART# 2:
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QTY# 2:
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PART# 3:
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QTY# 3:
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PART# 4:
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QTY# 4:
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PART# 5:
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QTY# 5:
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REASONS (PLEASE CHECK ALL THAT APPLY)
ARRIVED DAMAGED
CANCELLED ORDER
DEFECTIVE AUTOTEST
DEFECTIVE BALLAST/DRIVER
DEFECTIVE BATTERY
DEFECTIVE CHARGER BOARD
DEFECTIVE CIRCUIT BOARD
DEFECTIVE LED STRIP
DEFECTIVE OPTICAL LENS
DEFECTIVE TEST SWITCH
DEFECTIVE TRANSFORMER
DUPLICATE ORDER
JOB CHANGE/PRODUCT NOT NEEDED
PRODUCT ORDERED INCORRECTLY
RECEIVED INCORRECT COLOR
RECEIVED INCORRECT GOODS
RECEIVED INCORRECT QUANTITY
SHIPPED TO INCORRECT LOCATION
SHIPPED PRIOR TO RELEASE DATE
SAMPLES RETURN
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PLEASE PROVIDE A DETAILED EXPLANATION BELOW:
ATTACH PHOTOS:
(FILE FORMATS MAY BE PNG OR JPEG. SIZE RESTRICTED TO 5MB EACH. MAX 5 PHOTOS.)
FILES:
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