RMA Return Form

Claim Date *

Company Information

Company Name *

Contact Name *

Customer Name *

Company Phone Number *

Contact Email Address *

Invoice Number

Purchase Order Number

Lohmiller Return Location DenverEnglewoodCO SpringsJohnstown

Items Returned

Returned Part Number 1 *

Returned Part Serial Number *

QTY

Item in original unopened box with no writing on the item (Damaged units and/or items not in original packaging will not be accepted for return)*YesNo

If no, please explainExplanation

Returned Part Number 2

Returned Part Serial Number

QTY

Item in original unopened box with no writing on the item (Damaged units and/or items not in original packaging will not be accepted for return)YesNo

If no, please explainExplanation

Returned Part Number 3

Returned Part Serial Number

QTY

Item in original unopened box with no writing on the item (Damaged units and/or items not in original packaging will not be accepted for return)YesNo

If no, please explainExplanation

Returned Part Number 4

Returned Part Serial Number

QTY

Item in original unopened box with no writing on the item (Damaged units and/or items not in original packaging will not be accepted for return)YesNo

If no, please explainExplanation

Returned Part Number 5

Returned Part Serial Number

QTY

Item in original unopened box with no writing on the item (Damaged units and/or items not in original packaging will not be accepted for return)YesNo

If no, please explainExplanation

Returned Part Number 6

Returned Part Serial Number

QTY

Item in original unopened box with no writing on the item (Damaged units and/or items not in original packaging will not be accepted for return)YesNo

If no, please explainExplanation

Reason for Return (To speed up the return process please be as detailed as possible)*Reason for Return

Other CommentsOther Comments