Your P.O. Number:      

RTA Invoice Number:  

Company Name:         

Company Address:    

City:                               

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Zip Code:                     

Contact Person:        

Title:                             

Phone Number:         

E-mail Address:         

Item Being Returned

RTA Part Number:    

Quantity:                     

   Check one of the following:
      Repair/Replace
      Issue Credit

   Specific Reason for Return:

IMPORTANT NOTE - Disposition of all items is dependent on warranty coverage.

• Return authorization is subject to receipt of all goods being returned.
• Exceptionally authorized returns over 60 days old may be charged a 15% restocking fee.
• A confirmation will be sent to you immediately following receipt of your submission.