Please select RMA type : Repair Return Request Credit Return Request

Repair Return Request Form

Basic Information

Note: Fields marked with an asterisk (*) are required. Serial numbers must be given before a Repair RMA number can be issued.
Contact Person *
Company *
Customer ID *
Date *
Telephone # *
Fax # *
E-Mail *
Technical Contact Person *
Telephone # *
Fax # *
E-MAIL *

Billing Address (If Out-Of-Warranty)

Company Name
Address 1
Address 2
City
State *
Country
Zip Code

Shipping Address

Company Name *
E-Mail
Address 1 *
Address 2 *
City *
State *
Country *
Zip Code *

Repair Items

Part # * Serial #
(See Note above) *
Invoice # * Problem Description *
Note 1: Please provide BTOS serial number if entire system is being returned.
  • 1. Did the product work properly when you received it? * Yes No
  • 2. Please indicate the Operating System: *
  • Windows 95 Windows 98 Windows NT 4.0 Windows 2000 Windows XP DOS Windows 3.1
  • Other
  • 3. Have any changes been made to the product, application, or operating system since it was last working? *
  • Yes No
  • If yes, please specify:
  • 4. Is any third party hardware and/or software being utilized? *
  • Yes No
  • If yes, please specify:
  • Quotation before repair
  • Quotation before repair Warranty Repair Non-Warranty Repair
  • Cross Shipment Request ( Valid only within 30 days of original shipment and requires Advantech Management Approval )
For further details, contact: Tel: 1-888-576-9668 Fax: 408-519-3899