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Return Material Authorization
 
Liquid Controls RMA Request Form
Distributor Information/Submitter's Name:
Customer Purchase
  Order Number:
Liquid Controls Invoice Number:
(Invoice Number OR Serial Number is required)

Customer Information:
(If Available)
Submitter's Email:

Liquid Controls Model/Part Number:

Serial Number:
(Required for warranty replacement parts and equipment)
Date Installed into Service:

Date Removed from Service:

Product Handled:

Hours of Service: (If known)


Operating Conditions: (Provide as much information as possible)


Describe the specific nature of the claim: (Provide as much information as possible)


Please submit a Clean Sheet with your authorized return to assure the safety of our associates.

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