Return Merchandise Authorization Form

Return Merchandise Authorization Form
Name*

First NameLast Name
Company Name*
Email*
example@example.com
Secondary Email (will receive a copy of RMA request form)
example@example.com
Phone Number*
Company/Branch Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Customer Reference Number
Purchase Order Number*
Branch
Installer Name
Partner's Program Number
Product Description*
Detailed Description of Pump Failure*
What is the model number?*
What is the serial number?*
What is the date code?*
What was the install date (day/month/year)?*
What was the failure date (day/month/year)*
Please upload photo of the pump (include date code/model number/serial number label)*

Browse Files

Cancelof
Above is an example of the pump photo submission that is required to submit this form.
In order to receive credit for a Warranty claim you must have a F&W issued Return Authorization Number (RA#) which will be issued once the claim is submitted. No credit will be issued without one so take note of your RA# once one has been issued.
Should be Empty: