RMA Request Form

Step 1 of 3

RMA (Return Material Authorization) Request
Please complete the following four steps to accurately process your RMA request.

1. AGENCY INFORMATION: Where BI Incorporated should return repaired/replaced equipment.

Date

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Dates

Agency Name(Required)

Customer/Agency Number(Required)

Contact Name(Required)

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Agency Address(Required)

Street Address Address Line 2 City State ZIP Code

Street Address(Required)

Address Line 2

City(Required)

State(Required)

ZIP Code(Required)

Phone Number(Required)

Email(Required)

2. PRODUCT INFORMATION: A reason for return is required for all serial numbers. Select "Add Product" below to add more products.

Products

Product Name	Serial Number	Reason for Return	Actions

There are no Products.

FedEx Information:

Pack equipment including all accessories (i.e. chargers, batteries, power supplies, cords) in a cardboard box. Please leave the straps, batteries, and clips on the unit. Handwrite the RMA number or affix a label with the RMA number on the exterior of the box.

Any units exposed to BIOHAZARD risks such as TB, HIV, MRSA, or Hepatitis, must be returned in a securely enclosed, watertight bag, and then placed in a second securely enclosed, watertight bag. Label the second bag as BIOHAZARD and include the unit’s serial number.

Fedex Information(Required)

Agency will contact

BI will contact for ground pick-up

BI will contact for express pick-up

If you selected BI to contact, complete the information below:

Pick-up Address(Required)

Street Address Address Line 2 City State ZIP Code

Special Instructions

Total Number of Boxes

FedEx Receipt Number

Select + at the right to add more fields.

For non-warranty customers, BI will fax an assessment with an accurate invoice amount for repair. For customer-owned equipment that is not under warranty, a minimum $50 per unit charge will be applied for all equipment returned for estimate—even if no repair is authorized (charge does not apply to BI-owned equipment or leased equipment under warranty).

Name

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RMA Request Form

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