RMA FORM

Complete our on-line Return Authorization Request Form.
If you have a Lloyd or Jofra instrument that needs service or calibration please call 1-727-536-7831 To send your instrument in, you will need a return authorization number to be issued for repair/calibration work. In order to provide this, please complete the following information.
Step 1: Bill To
	Date*
	Customer ID (if known) (6 spaces 4 letters + 2 numbers)

	Instrument being sent in for:*	Annual Calibration 6 Month Verification (VPS Only) Repair (describe below)
	First Name*
	Last Name*
	Company*
	Job Title*
	Address 1*
	Address 2
	Address 3
	City*
	State/Province*	Abbreviation
	Zip/Post Code*
	Country*
	Phone*
	Fax*
	E-mail*
	Confirm E-mail

Step 2: Ship To
	(Same as Bill To Info)
	First Name
	Last Name
	Company
	Address 1
	Address 2
	Address 3
	City
	State/Province	Abbreviation
	Zip/Post Code
	Country
	Phone
	Fax
	E-mail

Step 3: Instrument Information
	Manufacturer*	Grabner Petrotest Other (type in below)
	Model/Type*
	Serial Number*
	Additional Comments/Notes

Step 4: Method of Payment
	PO #
	Credit Card (choose one)	MasterCard Visa Amex
	Credit Card #
	Expiration Date	(mm-dd-yyyy)
	Name on Credit Card
	Expedite my order	($100 service) if you want to expedite your order you must have your instrument to us 24 hours before: (mm-dd-yyyy) Click here for complete details
	Loaner	Yes I'd like to request a service loaner instrument ($750/mo.) Click here for loaner application, print, complete and fax to reserve your instrument.
	Loaner (choose one)	Grabner MINIFLASH Grabner_VPS
		*Please rate on a scale of 1 -3 how satisfied you are with your instrument 3 = Extremely Satisfied 2 = Satisfied 1 = Please contact me immediately
		*Required Field