To request a Return Material Authorization (RMA) number, please complete the form below. Upon completion, a representative will email you an RMA number and shipping instructions to return the items to Applanix. Please do not return any items without including an RMA number in the shipment. If information is unknown or not applicable, enter TBA or N/A.

* Indicates mandatory field

* Company Name:

* Address:

* City:

* Province/State:

* Country:

* Postal/ZIP Code:

* Phone Number:

* Customer Contact Name:

* Customer Contact Phone:

* Customer Contact Email:

* Have you contacted Applanix Support concerning this RMA?:

Applanix Support Contact :

* Ticket Number:

Returned Product Information:

* Business Line:

Part Number:

Serial Number:

Description:

Part Number:

Serial Number:

Description:

Part Number:

Serial Number:

Description:

Part Number:

Serial Number:

Description:

Part Number:

Serial Number:

Description:

Part Number:

Serial Number:

Description:

Part Number:

Serial Number:

Description:

* Reason for Return:

Return Shipping Information:

Is the return address the same as contact information above? :

Yes

* Company Name:

* Return Address:

* City:

* Province/State:

* Country:

* Postal/Zip code:

TAX ID # (US customs):

* Courier or Freight Forwarder Name:

* Courier Account Number:

Broker Information (if applicable):

Special Instructions: