Name
*
Company
Email
*
Phone Number
*
-
Area Code
Phone Number
Product Details
Select Type of Product
Actuated Surface Safety Valves
(Hydraulic)
- Model HX
- Model HWX
- Model HDX
(Pneumatic)
- Model DX
- Model PX
- Model PMX
Actuated Valve Control Systems
Expanding Gate Valves
- Model CX
- Model CSR
Slab Gate Valves
- Model FS
- Model FSR
OmniSeal Expanding Plug Valves
Purchase/Sales Order #
*
Serial #
*
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Total # of Items
Total # of Faulty Items
Details of the Problem (Please provide as much information as possible).
Desired action / action taken - RMA # requested or issued
Upload Product Images
Cancel
of
Submit
Should be Empty: