Return Material Form
Must be completed in full for credit
Location purchased (check one):
Location purchased (check one):
Manchester
Waltham
Portsmouth
Chelmsford
Franklin
Warwick
Weymouth
Contractor
Contractor name:
Business name:
Business address:
Email
example@example.com
City, State, Zip code:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Format: (000) 000-0000.
Fax:
Please enter a valid phone number.
Format: (000) 000-0000.
PO used/name:
Invoice number:
Customer
Name:
First Name
Last Name
Address:
City, State, Zip code:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Format: (000) 000-0000.
Product/Part Return
Manufacturer:
Case number:
Unit model:
Unit serial:
Part number(s):
Defective compressor regards model:
Defective serial number:
Replacement compressor regards model:
Replacement serial number:
Replacement unit model:
Replacement unit serial number:
Explanation of Failure(s)
Date of system install:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of failure:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of replacement:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Today's date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Prepared by:
Authorized by:
Description of failure:
Internal Use Only
Instructions
1. Information must be filled out and an explanation of failure must be detailed. (The word defective does not provide sufficient information.)
2. This Return Material Tag must be attached to the item. Please use the supplied label to ship item to us.
3. Warrantied parts must be returned within 30 days of replacement of defective part. (Warranty is invalid after 30 days.)
4. Contractor may be responsible for freight and processing charge.
Questions? Call the Warranty Department at (603) 668-7810.
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