RMA Request Form

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How to obtain an RMA number:
1. Call Velocite Systems at 443.572.0015 and inquire about an RMA number.
2. Fill out this form completely.
3. Write RMA number on this form in designated area.
4. Write RMA number on shipping container and place a copy of this completed form inside container.
5. If possible, please fax a copy of this RMA to Velocite Systems attention Vicki Hall at 443.572.0073

Requester:

* Name of Contact Person:
* Company:
* Phone:
* Fax:
* E-mail:

Failing System:

* Model:
* Serial Number:

Problem Description:

Components: (Please check all items being returned)

	MaxiLan		CD-ROM		Ethernet Card
	A/C Adapter		Floppy Drive		Modem
	Wall/Rack Mount Bracket		Hard Drive		Power Cable
	Cable Housing		Motherboard
	OTHER:

Incoming Inspection Comments: