RGA Form

RGA Form

Related Company (Check One):
KBR
Fleet Products
BC Fleet Products

New Product Return
Warranty
Re & Re
Call customer before commencing

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RGA# Issued:

Customer:

Customer Acct. #:

Contact:

Date of Purchase:

Invoice #:

Part Number & Description:

Manufacturer:

Date Installed:

Milage at Replacement #:

Reason for Replacement (Please be specific):

Customer Refernce #:

Date Submitted (mm/dd/yyyy):

Check Once:
Credit
Repair & Return

Signature:

Office Use Only

Warranty Completed (mm/dd/yyyy):

By (print name):

Signature:

PMS 15