BiB Ophthalmic Instruments - RMA Form
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Number
*
-
Area Code
Phone Number
Practice Name & Address
*
Practice Name
Street Address
City
County
Post Code
Product Name
*
Serial Number
*
Accessories Included?
*
Please detail all accessories included with the return. Example: Power Supply, Response Button, Lens Cap, USB Cable etc.
Request Type
*
Please Select
Sales Return For Refund
Sales Return For Exchange
Warranty Repair
Non-Warranty Repair (Chargeable)
Repair - Warranty Status Unknown
Fault Description
*
How Often Does The Fault Occur?
Please Select
Always
Most of the time
Sometimes
Randomly
Infrequently
Save
Submit
Should be Empty: