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2022 Repair Request Authorization Form

RMA & Repair Portal

Repair Request & Authorization Form

Official 2022 Repair Authorization standard. To facilitate processing, complete all relevant contact details, equipment configurations, and failure symptoms prior to submission.

Need Support Guidance?

Email your service queries to service@daihen-usa.com or Fax directly to 937.667.0885. Our dispatch team is ready to assist.

Equipment Shipping Target

Ship authorized items to: OTC DAIHEN, INC., ATTN: SERVICE, 1400 Blauser Drive, Tipp City, OH 45371. Include your RMA number clearly on all packaging.

Contact Information

Please supply accurate dispatch and verification details for both parties

End User Information

Warranty Requested

Distributor Information (If Applicable)

Description of Equipment

Complete models and matching serial sequences required for calibration tracking

Reason for RMA & Failure Classifications

Identify desired preventative services or fault states

Primary Reason for RMA

PM Interval Option:

Operation at Time of Failure

Type of Failure Observed

Authorization & Terms Acknowledgment

Authorizing representative must read and accept standard billing conditions

I hereby authorize OTC DAIHEN, INC. or its designated representative to provide standard technical labor, testing, and replacement repair parts as necessary. I acknowledge that a purchase order reflecting the Not to Exceed (NTE) Quote must be issued and verified prior to any repairs commencing. I understand and accept that failure to submit a valid purchase order within the specified timeframe will result in the described equipment being returned unrepaired, and return shipping fees may apply.
SIGNATURE AUTHORIZATION
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