|
Customer
Information
|
| Name:
(*Mandatory) |
| Company
name:
(*Mandatory) |
| Technical
contact:
|
| Telephone
#:
(*Mandatory) |
| Fax
#:
|
| E-mail
address:
(*Mandatory) |
| Chassis
serial #:
|
| Model
#:
(*Mandatory) |
| Customer
P.O. #: (at time of original purchase)
|
| L-3 Communications sales order #:
|
|
Product
Information |
| Part
description:
|
| Part
#:
(*Mandatory) |
| Serial
#:
(*Mandatory) |
| Revision:
|
| Description
of the problem:
(*Mandatory)
|
|
Payment
Information |
| Under
Warranty?
yes
no |
| Under
Maintenance Contract?
yes
no |
| Are
you interested in Advanced Turn Around (ATA)?
yes
no |
| Would
you like to be contacted for a price quote?
yes
no |
| Response
Information - RMA information should be sent
to: |
| Name:
(*Mandatory) |
| E-mail:
(*Mandatory) |
| Return
Ship to: |
| Address:
|
| City:
State:
Zip:
|
| Comments:
|
