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RMA-Input

Manager: John Garrity

Company:

For which table?

RMA Input Software Input Form Support Survey

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NOTE: Before entering data into this form, please make sure all required information is collected. This form cannot be saved and opened again later.

Customer Contact Information

To expedite the RMA Record process, please fill out this section as completely as possible.

Name *

Today's Date *

Company Name *

Phone Number *

Billing Address *

Return Ship Address (if different)

E-mail Address *

Return Parts List

All fields marked with an * are required

When returning an individual part from a system, provide the system serial number below, not the part serial number.

*Dover Part #

*Serial #
or UDI #

Cust. Part #

*Qty

*Description of Part

*Detailed Symptoms / Reason for Return

* Required Field

Instrument Decontamination Certificate

Please click the link below to download the decontamination certificate. Once downloaded, please complete, save and upload in the Additional Information section below.

41-1492 Instrument Decontamination Certificate

Additional Information

Corrective Action Required?

Add any related attachments here (photos, drawings, etc.)

Additional Comments

HAZARD FREE CERTIFICATION FOR RETURN

For purpose of obtaining a Return Material Authorization (RMA Record) for the product(s) referenced above, the undersigned herby certifies as follows:
   The product(s) has been fully rinsed and flushed clean of residual chemical, solvents and buffers. The rinsing and flushing complied with all OSHA and other application regulations.
   The product(s) has never been used with any hazardous, corrosive or radioactive material, including, without limitation, Hexaflouroisopropanol (HFIP), infectious, or microbiological substances and any other material that may be hazardous to human health or safety, or in any system or process involving the use of any such material.
   Listed below is a full, accurate and complete list of all chemicals, solvents and buffers that may have been used with the product(s) or in any system or process in which the product(s) has been used. Accompanying this HAZARD FREE CERTIFICATION is a Material Safety Data Sheet (MSDS) for each such chemical, solvent or buffer.

TYPE OF CHEMICAL,SOLVENT OR BUFFER (if applicable)

Hazard Free Signature *

RMA Ship From Location

Is the item being shipped back to Dover from within the United States? Check for "Yes"

Please click the �Save� button in the upper right corner before closing this page.

Foreign Shipper's Declaration

For below date field use the Date of ORIGINAL Export from the US, NOT the current date

I declare that to the best of my knowledge and belief the articles herein specified were exported from the United States, on or about the date

and that they are returned without having been advanced in value or improved in condition by any process of manufacture or other means.

Value of Item A above, U.S. Coin

Value of Item B above, U.S. Coin

Value of Item C above, U.S. Coin

Value of Item D above, U.S. Coin

Official Electronic Signature
Statements made for Foreign Shipper's Declaration are truthful.

Capacity / Title

Please click the �Save� button in the upper right corner before closing this page.

Show fields from Show fields from Show fields from a related table

a table related to ""

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Client Performance Report

Network latency: ()

The time taken for page load once the page is received from the server:()

The total process of navigation and page load: ()

From inline js at page top..
        .. to the time until docready:( s)
        .. to the time until window load begins: ( s)
        .. to the time until window load ends: ( s)

When you bring additional fields into a conversion, Quickbase often finds inconsistencies. For example, say you're converting your Companies column into its own table. One company, Acme Corporation, has offices in New York, Dallas and Portland. So, when you add the City column to the conversion, Quickbase finds three different locations for Acme. A single value in the column you're converting can only match one value in any additional field. Quickbase needs you to clean up the extra cities before it can create your new table. To do so, you have one of two choices:

If you want to create three separate Acme records (Acme-New York, Acme-Dallas and Acme-Portland) click the Conform link at the top of the column.
If the dissimilar entries are mistakes (say Acme only has one office in New York and the other locations are data-entry errors) go back into your table and correct the inconsistencies—in this case, changing all locations to New York. Then try the conversion again.

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RMA-Input

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Client Performance Report

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