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Thank you for using our on-line RMA system. Please fill out the following form for each item of equipment being returned for service. When you submit this form, the next page will provided a printable copy of your submission.
Payment Terms: All Potomac Instruments, inc. parts and service invoices will be restricted to one of the following:
1. Credit Card Transaction (Visa or MasterCard)
2. Payment in Full prior to shipment (CIF)
3. COD (to authorized accounts) |
| About the Equipment: |
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Model Number: |
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Serial Number: |
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Warranty Claim: |
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| Primary Customer Contact Person: |
Alternate Customer Contact Person: |
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Name: |
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Name: |
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Telephone: |
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Telephone: |
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FAX: |
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FAX: |
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E-mail: |
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E-mail: |
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| Company Name / Station Call Letters: |
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| Shipping Information: |
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Attention: |
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| Shipping Information (P.O. No., Street Address, Suite No.) |
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Address 1: |
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Address 2: |
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City, State, Zip: |
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| Billing Information: |
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Attention: |
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| Billing Information (P.O. No., Street Address, Suite No.) |
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Address 1: |
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Address 2: |
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City, State, Zip: |
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Nature of Service Requested, Symptoms Observed, Additional Information
& Special Instructions: |
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