RMA Request - General Dynamics Mission Systems SATCOM Technologies

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Customer Information

Company Full Name*

Address (Line 1)*

Address (Line 2)

City*

State/Province

Zip/Postal Code

Country*

Customer Contact Job Title*

Customer Contact First Name*

Customer Contact Last Name*

Contact Telephone*

Customer Contact Email Address*

Fax

Website

Ship from Location (Origin)

Use Customer Information Above to Fill out Ship from Location Address? Yes (Please check for accuracy)

First Name*

Last Name*

Address (Line 1)*

Address (Line 2)

City*

State/Province

Zip/Postal Code

Country*

Telephone*

Billing Information

Use Customer Information Above to Fill out Billing Address Information Section? Yes No

Department

RMA Request

Equipment Type*

Equipment Type (continued)*

Other (Please Specify)*

Issuing Location

Change Location?

Model Number

Part Number

Serial Number (or N/A if not applicable to RMA)*

Original PO # (if available)

Customer's Reference

Is this material U.S. Government Property?*

Reason for Return*

Reason for Return Other*

Detailed Failure Report*

End Use Statement

Did you or your company originally purchase this material from General Dynamics?*

Yes No

Is this material being used by the original End User?*

Yes No

Is this material being used for the original purpose for which it was purchased?*

Yes No

Return Shipping Information

Use Information From Customer Information to Fill out parts of the Shipping Information Section? Yes No

Freight Forwarder/Agent

Freight Account Number

Shipping Instructions*

Attachment(s)

Attachment

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