20701 Manhattan Place Torrance CA 90501 / Main: 800-889-9138 / www.amag.com
/ orders@amag.com
Date __________
Requested by_____________________________ Company Name ____________________________ e-mail: __________________________________ Phone Number _____________________________
Site/Project Name________________________________
Check one of the following options for repair: (Use the “insert” keyboard function to type into the form.)
AMAG Technical Support Ticket #__________________ AMAG Technician’s Name ___________________________
______ Advance Replacement (must have a valid AMAG Technical Support Ticket #)*
______ In Warranty Replacement (must have a valid AMAG Technical Support Ticket #)*
______ Out of Warranty Repair (must have a valid AMAG Technical Support Ticket #)*
______ Credit -- Original PO# (required) *
Reason for return for credit:
__________________________________________________________________________________________
__________________________________________________________________________________________
AMAG Part Number(s) QTY Reason/ Failure Serial Number(s)
Original P O #
Ship to Information
______ Replacement P O #
Bill to Information
_______________
To avoid processing delays, prior to submitting your RMA request for repair, please call our technical support department at 800-889-9138, option
3 to troubleshoot your unit(s) and to obtain a valid AMAG Technical Ticket #. You must have a valid SSA agreement in place and must be an
AMAG certified trained technician in order to call in. Please send your completed RMA Request Form to orders@amag.com
for processing. Please clearly mark the AMAG RMA number on the outside of the box. Your assigned RMA number will expire in 60 days.
Return to:
AMAG TECHNOLOGY
20701 Manhattan Place
Attn: RMA# __________
Torrance, CA 90501
A/RMA/SEPT_2015