RMA Form
Contact Information
Agency Name
*
Customer Contact Name
*
First Name
Last Name
Customer Contact E-mail
*
example@example.com
Customer Contact Phone Number
*
-
Area Code
Phone Number
Customer Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Customer Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional E-mails or Contact Info:
example@example.com
Equipment Information
Manufacturer Name
*
Select One
Polara
RTC Manufacturing, Inc.
GTT
Pelco
Southern Manufacturing
Dymec
Leotek
McCain
M.H. Corbin
Microhard
Myers Power Products, Inc.
Ameron
TraffiCalm
FLIR
APC (Schneider Electric)
Lilin
Product Name / Model Number
*
Serial Number(s)
*
Description of Issue(s)
*
After submitting, a PDF copy of this form will be sent to your Contact E-mail address. Please include a copy of the form when returning the units to the address listed above.
Repair Contact: Phone - 817.265.3421 E-mail - Repairs@CTC-Traffic.com
Submit
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