RMA Request & Return Form
(For GE INTERNAL USE ONLY)
RMA NUMBER: / I/C RMA NUMBER: / I/C SITE CODE:
Instructions:
- Please complete this form to request an RMA (Return Material Authorization) number and return to:
FAX: (256) 382-8459 International Phone: Country Code + 1(780) 420-2010
- This form will be sent back to you with an RMA number along with verification of the warranty status.
- You must include this completed form (which contains your RMA number) when you return the product(s).
- ALL fields are required to process your RMA request. Any fields omitted or incorrectly completed could delay receipt of an RMA number or increased processing and debugging time after the product is received
- If the form and product(s) are returned without an RMA number, the product may be returned without processing
- Please refer to the GE Intelligent Platforms Repair and Replacement Policy link below for all repair inquiries
Section A – Company Information
RMA Request Date:
Company Name:
Billing Address:
City, State, Zip Code:
Shipping Address (if different from above):
City, State, Zip Code:
Administrative Point of Contact (Name, Title):
Phone: / FAX: / E-Mail:
Technical Point of Contact (Name, Title if different from above):
Phone: / FAX: / E-Mail:
Section B – Product Information
Does your company require a PO Number to receive RMA products back in? YES NO / PO Number:
(PO required for all returns. If PO number not currently available, please include with return, or product may be rejected and returned without repair)
Is product being returned for Credit only? (Must Be Approved by GE Prior To Return) YES NO
Do you require your product to remain at the same revision? YES NO
Is product Export Controlled or ITAR restricted? (Please Explain):
Is product DPAS rated? YES NO If YES, what is the rating?
Please select one of the following Return Reasons and enter corresponding Code in the table below:
D - Product Damaged Upon Receipt P - Product Operationally Defective (See Section D)
F - Product Fit, Form, or Function Not As Advertised M - Product Missing Label or Component
W - Wrong Product / Part Number / Revision Received S - Product Not Per Statement of Work
I - Product Damaged During Customer Installation / Operation O - Other (Please Specify)
U - Product Upgrade Only (Customer will be charged for all Upgrade Only returns, regardless of Warranty status)
GE Part/Model Number /
GE Serial Number
/ Warranty / Return Code / Fixed Cost (GE USE ONLY)1. / ______YesNo / ______DFWIUPMSO
1. / ______YesNo / ______DFWIUPMSO
1. / ______YesNo / ______DFWIUPMSO
1. / ______YesNo / ______DFWIUPMSO
Section C – Shipping Information
Packaging and Shipping Instructions:
- Please ensure products for this RMA Request are returned in one shipment with all required documentation. GE is not responsible for the loss of product(s) as a result of multiple customer shipments using one RMA Number.
- All RMA products should be shipped to:
names on the outside of RMA packaging) Address To Be Provided By
RMA Coordinator
- Product(s) must be returned in the condition in which they were received. Modifications or damage may void warranty.
- Please follow proper ESD guidelines for packaging product returns. All products must be enclosed in protective ESD
Form: 82A1179-QD01 REV D February 5, 2010
If this is a copy, unless otherwise specified, it is uncontrolled. You must verify the revision before use.
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If Product Operationally Defective, please complete Section D for each Serial Number being returned to help us more quickly troubleshoot the reported problem. Please attach additional pages if needed.Section D – Product Operationally Defective
Has Serial # previously been returned to GE Intelligent Platforms on an RMA? YES NO Unknown
If YES, please provide RMA #:
Please explain reason for previous return:
Operating System & Other Software Components (If Applicable):
Was product functional upon arrival? YES NO
Will product boot properly? YES NO N/A
Are multiple Serial Numbers of the same Part Number exhibiting similar problem(s)? YES NO
Has GE Intelligent Platforms Technical Support been contacted to report problem? YES NO
If YES, please list Technical Support Case #:
Did problem occur during first installation? YES NO
Have there been any customer-performed modifications to product hardware or software? YES NO
If YES, please explain:
Have there been any changes to your system that could have resulted in problem? YES NO
If YES, please explain:
Has a system problem been resolved by substituting for a known working product? YES NO
Is the problem related to: Hardware Functionality Software Functionality Unknown
Is the problem: Intermittent Constant Unknown
Is the problem typically observed at: (Please Check All That Apply)
High Temperature Low Temperature Nominal Temperature Temperature Transitions Unknown
Briefly explain any installation, testing or troubleshooting procedures your company performed prior to product return (Environmental Stress Screening (ESS) testing, putting product into an identical or separate system, substituting cables or power supply, etc.):
Briefly explain any additional information that could be helpful to our technicians in testing, diagnosing or repeating the problem (Error messages received, LED status, etc. Please attach any photos, diagrams, test results, programs or code fragments that further demonstrate problem and return with this form):
A standard RMA Report with technician findings and repairs performed (if applicable) is provided for RMA returns. If you require more detailed information, please specify requirements below: (Detailed requests will be provided for products returned for quality defects only. Additional charges may apply, regardless of warranty status)
Form: 82A1179-QD01 REV D February 5, 2010
If this is a copy, unless otherwise specified, it is uncontrolled. You must verify the revision before use.
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