RMA Maintenance Request

NOTE: This request and correspondence is via email, if you do not have an email address please call Legacy Inc. to request an RMA.

For customers without a maintenance contract or equipment under warranty, please make sure your information is complete. Items with asterisks represent required inputs. If you have any questions please call Legacy Incorporated main office at 1-866-271-9891.

RMA Information

Repair Type:		Date:
Existing Customer:	Yes No	Customer Number:
Under Warranty:	Yes No	Warranty Through:

Billing Information

Billing Information		Shipping Information Same **required if shipping is different
First Name:		First Name:
Last Name:		Last Name:
E-Mail:		E-Mail:
Company:		Company:
Address:		Address:
Suite No.:		Suite No.:
City:		City:
State:		State:
Zip:		Zip:
Phone:	ext:	Phone:	ext:
Fax:		Fax:

Equipment Information

Manufacturer:	Model:	S/N:

Problem Description:

*Add Additional Equipment

Manufacturer:	Model:	S/N:

Problem Description:

Manufacturer:	Model:	S/N:

Problem Description:

Manufacturer:	Model:	S/N:

Problem Description:

Manufacturer:	Model:	S/N:

Problem Description:

Additional Billing Information

PO Number		Required for all Flat Rate Repairs
Do you wish to add an expedite fee of $75.00 per each repair for faster turn-around (only applies to Flat Rate Repairs)
Yes, expedite my repair for an additional $75.00		No, Don't expedite my repair for an additional $75.00
Return Shipping Method:
Comments:

Repair Request

RMA Maintenance Request

RMA Information

Billing Information

Equipment Information

*Additional Billing Information*

Additional Billing Information