Request for Return Material Authorization

Please complete as much of this form as possible –This will help us to progress your return quickly.

Company Name	*	Quantity Returning	*
Address		Gems Part Number	*
City/St/Zip		Original Purchase Order #	*
Primary Contact (first and last name)	*	Media / Chemical Exposer	*
Email Address	*	Gems Sales Order Number
Phone Number	*	Customer Part number
Fax		Customer Internal Case/RA #
Gems Invoice Number		Date Code
Reason for Return *

Requested Disposition

If deemed Warranty

	Repair and return


	Issue credit/scrap *


	Return for credit **

* may not be available for all items.

** not avaialbel for all products. Fees may apply.

If deemed Non-Warranty

Scrap

Repair (if possible/economically feasible)

Repair PO#
Max Repair Cost
Return Carrier		Account#

Return (as is)

Return Carrier

Account#

Customer Comments

Please attach all DMR, pictures and document to support your case:

I accept all Service Terms below:

Please note that an evaluation charge could be applied, if we find that the product is “no fault found”, “damaged due to Mis-use” or “Out of Warranty” over a year old.
£250 will be charged for all up to 10 units, £400 for 11-20 units and £600 for 21-30 units + £30 per shipment for packing and carriage (D4).
No RA number will be issued if the items are below the value of £75, if units are within warranty (less than 1 year old) these will be replaced under warranty (credit and rebill applies).
If the product is in within warranty and it is faulty by a manufacturing error the original shipment costs will be reimbursed.
Goods not returned within 30 days from issued R number will not be accepted.
No units will be accepted without a valid R number and will be returned to customer without inspection.
Before returning units back to Gems Sensors Service Department.Please insure that you have wired and are using the correct voltage supply as per the unit’s label. This could prevent a “no fault found” situation, which may result in a charge.

Note: The charge is for performing the evaluation. The charge does not include the cost of repair or replace.

IF UNIT IS BEING SENT BACK AFTER USE, PLEASE ENSURE IT COMPLIES WITH HEALTH AND SAFETY REQUIREMENTS. THE INSTRUMENT MUST BE CLEAN AND SAFE TO HANDLE AND ACCOMPANIED BY A FORMAL STATEMENT TO THAT EFFECT.

If no response is received within 30 days to our service report, Gems Sensors and Controls reserved the right to scrap the units within 30 days.

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