Return Authorization Request

Upon return receipt of this completed form, WPC will issue the Return Authorization # and provide the specific WPC location for the item(s) to be returned for repair. Please mark the outside of all shipping containers with the RA# and return freight prepaid. Depending on the system, WPC may issue separate Return Authorizations and return addresses.

In order to provide the best possible service, it is essential this document is completed and returned to WPC before a Return Authorization is issued. RA#'s will not be given without a returned, completed form.

Bill To:		Ship To:	Same As Billing
Company:		Company:
Address 1:		Address 1:
Address 2:		Address 2:
City:		City:
State:		State:
Zip Code:		Zip Code:

Purchasing Department Information		Phone #	Fax #
Purchase Order #:
Shipping Method		Shipping Acct #:
Other Shipping Method:		In the absence of an account #, WPC will ship Pre-Paid & Add

Please provide a contact name in the event our inspection/testing finds no problem with the item returned.
Contact Name:		Title:
Email:		Confirm Email:
RA #'s will be sent to the e-mail address provided. In the event that we do not receive an E-mail address, WPC will send the RA# to the fax number provided.

Part #	Serial #	Description of Problem (Be Specific)

Return Authorization Request

Bill To:

Ship To:

Purchasing Department Information

Part #

Serial #

Description of Problem (Be Specific)

Support