RMA Test Return Authorization Form (1) Bill To InformationCompany Name* Name* First Last Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Is the Ship To Information the same as above?*YesNoShip To InformationCompany Name* Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Shipping Method*FedExUPSDHL AirUse best choice availableFedEx Collect # or Prepay and Add DHL Air Collect # or Prepay and Add UPS Collect # or Prepay and Add Is the Technical Contact Information the same as above?*YesNoName First Last Email PhoneReason for Return*RepairRecalibrationWarrantyReturn for CreditAW-Lake units to be repaired Meter Sensor Monitor(s) (Displays) Displays are Reprogrammed in GPM unless otherwise specified.Type of MeterPositive DisplacementTurbineCoriolisVariable AreaUltrasonicNot SureQuantity of MetersCall for AuthorizationI have additional meters I need repaired.YesNoAdditional Meters Positive Displacement (Gear) Turbine Coriolis Variable Area Ultrasonic Vogtlin Thermal Mass Not Sure Product*SensorQuantity of SensorsProduct*DisplayQuantity of DisplaysAW-Lake units to be recalibrated Meter Sensor Monitor(s) (Displays) Displays are Reprogrammed in GPM unless otherwise specified.Meter Recalibration Type*Positive Displacement (Gear): 5 point recalibrationPositive Displacement (Gear): 10 point recalibrationTurbine: 5 point recalibrationTurbine: 10 point recalibrationCoriolis: 5 point recalibrationCoriolis: 10 point recalibrationVariable Area: 10 point recalibrationVariable Area: Bi-Directional MetersUltrasonic: 3 point recalibrationNot SureQuantity for MetersProduct to be Recalibrated*SensorQuantity of SensorsProduct to be Recalibrated*DisplayQuantity of DisplaysAuthorization up to $0.00 Authorization up to $0.00 Number of Units Part Number/Serial Number*Click plus symbol located on the right to add additional quantities.| Part Number| Serial Number Describe in as much detail as possible why the unit(s) needs to be returned*Specific Requirements and/or Additional Information*Original PO#* HiddenPayment MethodPayment Method*Purchase OrderCredit CardAW-Lake will contact you for credit card information once the RMA has been received. Thank you!PO#* *Please include a copy of your PO with your return, if possible, or email your PO to returns@aw-lake.com **By providing AW-Lake your PO Number, this gives AW-Lake permission to proceed with requested repair and/or recalibration, charging up to the amount advised above. Thank you!HiddenReturn for Credit Policy:15% restocking fee if a replacement is ordered. If not, there will be a 30% restocking fee. Credits are not issued until part(s) are inspected and are found in 'like new condition’. Returning unit(s) are within ONE year of purchased date. Declaration of Hazardous Material and DecontaminationDear Customer,*For the safety of our AW-Lake employees and to comply with both DOT and OSHA regulations, are you returning equipment / material that has been exposed to any hazardous material? If yes, please complete the information below before returning any equipment or material to the factory.Please select...YesNoType of Hazardous Material*Please select...RadioactivePoisonousHealth HazardBiohazardFlammableOtherProcess/Medium Concentration* Decontaminated and Cleaned with* Hazardous Material Decontamination Agreement*I hereby certify that the returned equipment has been cleaned and decontaminated and is compliant with all regulations. This equipment posses no health or safety risks due to contamination. I agree to the terms above ATTENTION CUSTOMER:Return Information*All returned flow meters MUST BE FLUSHED and CLEANED of material BEFORE returning to AW-Lake. In addition, all FITTINGS must be removed as well.Failure to do so will result in either return of your part(s) at your expense and/or extra expenses. Once the form has been submitted and reviewed, AW-Lake will issue an authorized RMA (Return Material Authorization) number and return form to the above listed contact. All products returned must be accompanied by the completed RMA form and the Hazardous Material Form, if applicable. The authorized RMA number must be visible on the exterior of the package. The RMA number is valid for 30 days from the date it was issued. Any products left at AW-Lake for longer than 60 days with no communication from the customer will be discarded. All products must be packaged in a way as to prevent damage during transportation back to AW-Lake's facility. Do not use packaging peanuts please. Failure to comply with this requirement may result in no credit being issued for your return or additional fees to repair the damage done during transport. Packaging instructions can be provided at your request. I agree to the terms above Note:After you’ve submitted and received your authorized RMA#, our mailing address is: AW-Lake 2440 W. Corporate Preserve Drive, #600 Oak Creek, WI 53154 Δ
