Please complete information below. Your unique RMA number is displayed at the top of this form. Please use this number when communicating with Select POS about your repair. Upon completion of this form, an automated email will be sent to you confirming your RMA information. Thank you!

Date:

RMA# (RMA Number CAN BE used for multiple repair items.)

Company Name:

Bill to Address:

Attention:

Street Address: City:

State: Zip:

Ship to Address: same as Bill to Address

Company Name:

Attention:

Street Address: City:

State: Zip:

Contact Name*: (* required fields)

Phone Number*: Email Address*:

Item(s) being shipped for repair:

Your Reference or PO Number: (NOT required, but helpful)

Expedited Repair Option (Only valid if box is checked)

In order to better accommodate our clients needs, we are now offering a Expedited Repair Option. Repair orders can be expedited on a 48 hour turnaround from receipt of equipment (not including return shipping time). This service will be offered for a 30% up charge of the original repair cost and will be returned to you via UPS Next Day Saver, (additional charge).

Comments (Please include any special requirements):

Return shipments will be shipped UPS Ground (Uninsured) unless
otherwise indicated in the Comments area above.

PLEASE NOTE: Select POS is NOT responsible for ensuring Patient Readiness upon receipt.
Six month warranty will cover all parts and labor associated with the repair of items,
cosmetic and physical damage will be billed back to the customer.

"Our goals are simple
and very straight forward. We are here to satisfy
your needs now and
into the future.

Our services include:

©Copyright 2008, All Rights Reserved. Select P.O.S. & Peripherals, LLC. For more information contact us at 1.866.559.3500 or email information@selectpos.com