Modine Warranty Form

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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
PrepaiedCollect

Return Type
In Warranty MaterialNon-Warranty InspectionIncorrect Material Received Ordering ErrorExcess Inventory

Other

_____________________________________________________________________________________

Modine Reserves The Right To Perform Destructive Tests And Dispose Of Material Returned For Analysis

_____________________________________________________________________________________

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
CreditNo Charge Replacement

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

Return to
BVWKRRacine

R.M.A. Void After

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