RMA Form

Title^*

Organization^*

First Name^*

Last Name^*

Street / Number^*

Zip Code^*

City^*

Country^*

State/Province ^*

Phone (if any questions arise)

Email^*

Nanotec Customer Id (if known)^*

Order / PO no. ^*

	Nanotec part no.^*	No. of returned articles^*	Serial no.^*
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Description ^*

UPS return label? ^*

Yes No

Please use one of these file formats: PDF, DOC, DOCX, JPG, PNG
max. filesize: 5M

We hereby confirm that the returned product is not contaminated with substances that pose health or environmental risks. ^*

Customer is responsible for shipping charges to Nanotec.
A $120.00 evaluation fee is applied to all RMAs, plus shipping costs and sales tax (waved for items under warranty.)
Warranty and evaluation will be subject to Article 11 of Nanotec Terms and Conditions.

^* Mandatory fields