Return Material Authorization Form (RMA)

Incident Form / Return Material Authorization

Login to have your billing and shipping information loaded from your account.

Please complete this form and send it along with the item(s) being returned to

Intoximeters, Inc.
2081 Craig Road
St. Louis, MO 63146

If you are sending an item for repair, receipt of this completed form is required for the repair process.

Federal Law concerning the shipment of dangerous goods (Dry Gas Standards): Some versions of the EC/IR and AMCC have Dry Gas Standards housed inside. These should not be in the instruments when they are returned to us for service. The shipment of Dry Gas Standards without proper dangerous goods labeling is against the law. It can also damage the regulator and the instrument if the shipment is subject to rough handling during shipping.

Contact Intoximeters before returning a Dry Gas Standard.


Bill to Company Information

Same as Ship To
* Company  
  Email  
* Phone    
Format: (###) ###-#### or
  (###) ###-#### x###
  Fax  
Format: (###) ###-####
* Address  
  Suite
* City  
* State  
* Zip    
 

Ship to Company Information

Same as Bill To
* Company  
  Email  
* Phone    
Format: (###) ###-#### or
  (###) ###-#### x###
  Fax  
Format: (###) ###-####
* Address  
  Suite
* City  
* State  
* Zip    
All repairs are returned via ground service unless otherwise requested. If you would like a faster return method please select an option below.
* Your account will be billed accordingly.  

Instruments

Please click "Add Return Instrument" and enter the Instrument Model, Serial Number and Reason for Return for each item being sent for repair.
Add Return Instrument
 Instrument ModelSerial NumberReason For ReturnDelete
No records to display.
 
Note: Intoximeters reserves the right to return the instrument in the same condition as it was received along with an invoice for the appropriate checkout charge per unit, plus all shipping charges if we do not receive a response within 15 days of the e-mailed / faxed estimate.

Authorization

Choose either Repair Request A or B


Payment Option 1, 2 or 3


  PO# (For Payment Options 2 or 3)

Authorized By

  *Contact   *Email   *Phone  Format: (###) ###-#### or (###) ###-#### x###
       

Please type the numbers you see below into the textbox beside it to submit the form.

910775

 
* Required Fields