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RA Request Form

Please provide the following contact information.      Required Fields(*) :

Contact Name:*
Phone#:*
(incl. area code)
FAX#:
(incl. area code)
E-mail:*
JMAC Invoice #: (all Items for each Request must be from the same invoice)
JMAC Item #
Enter Item(s) to return below		 Qty to
Return		 Serial #(s)
New and Unopened Product Request Replacement
Defective Products Request Credit Only

Reason for return:


Please provide Customer Reference No:
Customer Ref#

Please read important return Information