Microsemi Products RMA Form

  1. Company*
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  2. Sales Contact
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  3. Sales Contact's Phone
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  4. Sales Contact's E-Mail
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  5. Technical Contact*
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  6. Technical Contact's Phone*
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  7. Technical Contact's E-Mail*
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  8. Return Attention
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  9. Return Street Address
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  10. Return Street Address (Cont)
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  11. Return City
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  12. Return State/Province
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  13. Return Zip / Postal Code
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  14. Product Information

  15. Product #1 * Product #2 Product #3 Product #4 Product #5
    Part Number*
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    Product Model/Description*
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    Unit Serial #(s)*
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    Failure Code*
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    Brief description of failure or problem symptoms
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    Attachment related to the repair
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    Was this unit Dead on Arrival
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    Do you have a support contract?
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    Service Contract Number
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  16. Have you spoken to Technical Support about this?
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  17. End User Name
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  18. Non-USA Street Address
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  19. Non-USA Street Address (Cont)
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  20. Non-USA City
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  21. Non-USA State/Province
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  22. Non-USA Zip / Postal Code
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  23. Non-USA Country
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  24. U.S. Export License Number
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  25. Non-USA Phone
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  26. Please verify that you are not a robot.