R.M.A. Request Form

Please complete all sections of this Return Material Authorization Request Form

Carefully review Concealite Life Safety Products Inc.’s Terms and Conditions, as all sales are subject to these terms. The purchaser is responsible for understanding these terms.

Distributor Contact Information

Company Name

Company Address

Address Line 1

City

State / Province / Region

Postal Code

Contact Name

Phone

Order Information

Contact Product File

Original Purchase Order Number

Original Purchase Order Date

Project Name

Project State

Product Information

The following product details are to be provided. Total quantity of product to be sent for evaluation. List catalog suffix and product serial number. For product in original packaging provide catalog suffix only. Multiple Product return entries should be separated by product type. If you are returning more than one product type click the “Return Another Product” button below to list more returns.

Quantity

Product Catalog Suffix & Serial Number

Please provide a detailed description of the issue or reason for the return below. Provide as much detail as possible as this will directly affect the approval process. Photo documentation is highly recommended and should be uploaded on the file upload portion on this form.

Reason For Return

File Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

A return request will be formally authorized with an (RMA) form and case number documenting the next steps in the process, terms for return credit, instructions for returning the product and final evaluation.