Return Material Authorization

"*" indicates required fields

1Step 1: RMA Details

2Step 2: Contact Information

RMA Details (optional)

RMA Number / Complaint ID / SC Number

Contact Person at BVL/BVS (optional)

Customer Data:

Title, first & last name*

Company / University*

Department*

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Returned Items:

Serial Number is required. If no serial number or article number, type "0".

Items

Quantity

Article Number

Product Description

Serial Number

Returning Reason

Reason for return / Problem description per item*

Repair Procedure:

Repair Procedure:*

YES, I will accept all associated costs arising from inspection, maintenance & performance test, cleaning, handling, repair & parts without receiving a quotation in advance if the overall amount does not exceed $650 per article (shipping costs and local taxes not included).

NO, I will not accept repair work without receiving a quotation in advance. Please send me a quotation.

Damaged Equipment*

Send equipment that is damaged beyond repair back to me.

Note: If this box is unchecked we will dispose of equipment that is damaged beyond repair.

Contact for quotation/billing:

Please complete this part only if the quotation/billing address is different from the Customer Data.

Same with the Customer Data on the first page?

same with the Customer Data on the first page

Title, first & last name*

Company / University*

Department*

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Shipping Address:

Please complete this part only if the shipping address is different from the contact for quotation/billing.

Same with the Customer Data on the first page?

same with the Customer Data on the first page

Same with the contact for quotation/billing?

same with the contact for quotation/billing

Title, first & last name

Company / University

Department

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Further comments:

Comments

I hereby confirm that the equipment I'm returning is:

properly cleaned

disinfected

I'm aware that otherwise, Brain Products may charge a cleaning/disinfection fee. The fee (amount due) depends on type and quantity of equipment.

Signature*

Date*

Return Material Authorization

RMA Details (optional)

Customer Data:

Returned Items:

Repair Procedure:

Contact for quotation/billing:

Shipping Address:

Further comments:

Products & Solutions

About Brain Vision

About Brain Vision Solutions

Return Material Authorization

RMA Details (optional)

Customer Data:

Returned Items:

Repair Procedure:

Contact for quotation/billing:

Shipping Address:

Further comments:

Website Search

Schedule a call with our Consultants​

Schedule a call with our Consultants