Return Request Form

This is a Return Request form. It is NOT the authorization to ship. After submitting this form, if approved, a PO will be put in place, and we will send an authorization number. That number will need to be attached to the shipment for return. Please do not send the unit prior to or without the authorization attached, our shipping department cannot accept the shipment without it.

Customer Full Name:

Date(Required)

Company Name(Required)

Company Address(Required)

Street address, city, state, zip code

Phone Number(Required)

Fax Number

Email Address(Required)

Material to be returned: Packing list Customers please be specific when completing this section. If you do not have/know the serial number, you may leave the section blank.

Material Name

Serial Number

Material Name

Serial Number

Material Name

Serial Number

Material Name

Serial Number

Material Name

Serial Number

Description of the Problem:(Required)

Acknowledgment Required. Initial below to confirm you have read and agree to the above shipping requirements. Initials:

Check this box if no work is to be performed prior to customer approval.

ALL MATERIALS returned to Thermionics MUST BE CERTIFIED FREE of hazardous materials or induced activation. Please list all hazardous and nonu0002-hazardous materials that the equipment has been exposed below.

Hazardous Materials:

Comments:

Certification: I certify that I have disclosed all substances the equipment has been in contact with since it was unsealed from its original packaging. I understand that any error or omission in this declaration may result in customer liability for associated fines, fees, or damages. Authorized by (full name):

This field counts as the authorization signature for this return.

About Us

ABOUT US

Products

Success Starts with the Right Equipment

Services

Services

Return Request Form

CALL US:

FOLLOW US:

EMAIL:

SIGN UP FOR OUR NEWSLETTER