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Modine Warranty Form
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Modine Return Material Authorization
All Returned Material Must Be:
1) Properly Labeled
2) Packaged To Withstand Normal Hazars of Transportation and
3) To Be Shipped
Return Type


Other
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Modine Reserves The Right To Perform Destructive Tests And Dispose Of Material Returned For Analysis
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Customer Name *
 
City *
 
State *
Customer Reference Number
Modine Order #
Replacement or Original Invoice #
Customer Acct. #
Rep Code
Note: please do not use 'defective' as reason for return.
Material Returned For
Reason for Return
Installation Name & Address
Name
Street
City
State
Zip code
Date Installed
Date Removed/Failed
Please enter the unit serial number below if this section is filled.
Material To Be Returned By
Name
Street
City.
State.
Send R.M.A. To (Name & Address)
Name.
Street.
City.
State.
Zip code.
Fax Number
e-mail Address
_____________________________________________________________________________
Quantity
Complete Unit Model Number
Unit Serial Number
Part Name/Description
Part Model No. (if available)
Part Serial No. (if available)
Material Disposition
 
Issued By *
Date
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R.M.A. Void After
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