TO PRINT THIS FORM OUT IN MICROSOFT WORD

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TO REQUEST A RMA NUMBER, FILL THIS FORM OUT IN AND FAX IT TO 415-435-4873. WE WILL FILL
IN THE RMA NUMBER AND FAX IT BACK TO YOU.

*When shipping in your equipment fill this form out and send it in along with the equipment.  

Ship-To:
MOORE'S ELECTRONICS                                                                                                                                     
548 Virginia Drive
Tiburon, CA 94920
Phone: 415-435-3712
FAX: 415-435-4873              
Email: sphelps@mooreselectronics.com                                
WWW.MOORESELECTRONICS.COM

Company Name
Shipping Address
Billing Address
Contact Name				Tel				Fax
PO or Call #       (if required)				Email
Billing Method	Bill w/approved credit		COD				Visa/MasterCard

Equipment Information: (Please use one form for each piece of equipment)

Model Number

Serial Number

Description of Problem

Special Instructions

Estimate Required?

Yes

No

Warranty Repair?

Yes

No

Return Via (select below):

UPS Ground

UPS Red

UPS Blue

UPS 3rd

Fed Exp

Other

IMPORTANT POINTS TO REMEMBER
•  Be sure to use a sturdy safe box or use original packing if available.  Insure contents.

•  Do not pack heavy equipment in Styrofoam “peanuts.”

•  If peanuts are used, secure VCR cassette door so that peanuts do not get inside machine.

•  If warranty repair, enclose a copy of original invoice.

•  Enclose this form in box with equipment to repair.  (Keep a copy for your records.)

•  Use one form for each piece of equipment to be repaired.

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