Applanix - Request RMA Number

Request an RMA Number To request a Return Material Authorization (RMA) number, please complete the form below. Upon completion, a representative will email you an RMA number and shipping instructions to return the items to Applanix. Please do not return any items without including an RMA number in the shipment. * Indicates mandatory field
Contact Information
Company Name: *
Address: *
City *
Province / State: *
Country: *
Postal Code/ Zip Code: *
Phone Number: *
Fax Number: *
Primary Contact: *
Primary Contact Phone: *
Primary Contact email: *
Secondary Contact (optional):
Secondary Contact Phone:
Secondary Contact email:
Applanix Support Contact (if applicable):
Ticket Number *		Ticket Number
Returned Product Information
Item 1 to be Returned: *		Describe the item to be returned
Part Number 1: *		As printed on product label
Serial Number 1: *		As printed on product label
Reason for Return 1: *		Describe why this item is being returned to Applanix
Item 2 to be Returned:
Part Number 2:
Serial Number 2:
Reason for Return 2:
Item 3 to be Returned:
Part Number 3:
Serial Number 3:
Reason for Return 3:
Return Shipping Information
Return Address: *
City: *
Province / State: *
Country: *
Return Postal / Zip code: *
TAX ID # (US customs): *		Mandatory for US customers. Non-US customers please enter "NA' here.
Carrier/Freight Forwarder: *
Broker Information (if applicable):		For returns outside North America, enter your broker's address and contact details
Special Instructions:
*