LPC Technology, Inc

Return Merchandise Authorization request form

By fax this RMA form, I read and agreed the conditions of the RMA policy

LPC Fax number: 909-598-2710 Phone: 909-598-1266

Company Name: ________________________

Completed By: ________________________

Address1: __________________________________________

Address2: __________________________________________

Tel: ____________________________ Fax: ________________________________

RMA #: _________________________ Date issued: __________________________

Item Number

QTY

Invoice #

Serial #

Problem Description