Request Return Authorization

Parts to Return

Product Serial Number

Problem Description

Details of the problem, including any troubleshooting steps

Please provide as much detail as possible. If any troubleshooting steps were taken, please list them here. For product returns, include the purchase order or invoice number and note that a 20% restocking fee applies.

Did you default the unit to factory settings?

Yes

Customer Contact

Contact Name*

Provide the contact information for the primary contact. For returns, this person will receive information regarding the restocking fee and credit. For repairs, this person will receive the service estimate and will be contacted with any follow-up questions.

Customer ID

PolyScience customer number

Phone

Fax

Billing Address

Country

First Name

Last Name

Company

Address 1

Address 2

City

State

ZIP code

Shipping Address

Country

First Name

Last Name

Company

Address 1

Address 2

City

State

ZIP code

Return Shipping

Shipping

Ship freight prepaid/added to repair charges.

Ship freight collect to your account.

Carrier (if applicable)

Account Number (if applicable)