Returned Material Report (RMR)

This form is for repairs and warranty issues only.
Do not return product for credit on this form.


Account Number


Date:   Pick a date
Attn: Repair Department
1000 Armstrong Drive
Fairmont, MN 56031, USA

Phone: 507-238-4461 / 800-533-0456
Fax: 507-235-8291 / 800-368-2042

Email: rmr@awtx-itw.com
Expedite this order and I agree to pay the expedite fee.

This area must be complete to properly process your request


Purchase Order/Reference #

Bill To/Company:
Name
Address
City, State, Zip
Contact Name
Phone
Ship To/Customer:
Name
Address
City, State, Zip
Contact Name
Phone

Model #
Serial #
Action Requested:
Parts credit
Recalibration
Non-Warranty Repair
Warranty Repair
Warranty Replace
Exchange Warranty: (Replacement Sent)
          Warranty Sales Order #
Service Exchange Weighline Rail:
          Sales Order #
Return Ship Method:
Red (overnight service)
Blue (2nd day service)
Orange (3rd day service)
Ground
Other:

Shipping Account:
Account #

List each item being returned on this RMR. Use Avery Weigh-Tronix
part numbers, if known, or describe each item completely


1. Quantity Part # Description
Failure symptoms or reason for return

2. Quantity Part # Description
Failure symptoms or reason for return

METHOD OF PAYMENT (select one)

Credit Card       C.O.D (Note: C.O.D. has an additional charge of $5.50)

Please provide the responsible parties contact information for payment:

Contact Name Phone Number
Email Address


PLEASE NOTE EFFECTIVE FEBRUARY 2, 2015 A STORAGE FEE OF $50 PER MONTH
WILL BE CHARGED TO YOU IF PROMPT PAYMENT IS NOT RECEIVED.

COST ESTIMATE (Note: Check this box if you would like us to call with a cost estimate before proceeding with the repair.)
TAX EXEMPT (Note: Check this box if you are tax exempt. If tax exempt, please include a copy of your tax exempt certificate.)


Additional Instructions

Please complete and send a copy of the RMR form along with the product. Keep a copy for your records.




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