Return Authorization Form Printable

Primary Contact*

Email*

Telephone Number*

Fax Number

Address

Bill To Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Address

Same as Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Instrument Information

Model Number

(if known)

Serial Number

(if known)

Purchase Date

(if known)

Service Required*

Repair or Return (calibration separate)
Calibration
Reprogramming (general) $50

Repair or Return

Repair*

Please describe the problem or reason for return.

Calibration

Model 7084VP+, 7064VP+

Level I ..$65
Level II ..$95

10430VP+, 10431VP+, 10433VP+

Level I ..$85
Level II ..$115

PA201, 201X, 202, 202X, 203X, IRIS, IRIS+

Level I ..$100
Level II ..$130

VIP1 Inline

Level I ..$400

VIP2 Inline

Level I ..$100
Level II ..$150

Reprogramming

Reprogram for the following fluids and units of Measure*

Scale#	Scale Name	Unit of Measure

Payment Method

Payment Method Options*

I have a MISCO Net 30 account.
Credit Card (please call)

Estimates are always given on non-warranty repairs. Payment information MUST be received prior to work being performed.

Please use my Account's PO # against my NET30 Account

Please call me at this# for my Credit Card Information

**NOTE: Unclaimed instruments and/or accessories will be discarded 60 days from the date you receive your return results.

Return Shipping

Return Shipping Method*

UPS Ground
UPS 1st Day
UPS 2nd Day
UPS COLLECT
FEDEX COLLECT 1st Day
FEDEX COLLECT 2nd Day

Carrier Account Number

Residential Address

Yes it is.. I love refraction at my house.

Return Authorization (RMA Form)

Address

Instrument Information

Repair or Return

Calibration

Reprogramming

Payment Method

Return Shipping

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