Toshiba Industrial Division

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Return Authorization Form

Please read the conditions below before filling out this form.

All repair work is billed at $ 100.00 per hour plus parts unless specified as a "Flat Rate Repair". The minimum charge for all repair work will be $ 100.00 Payment terms are Net 30.
All returns must bear a VALID return authorization (RA) number. RA numbers are valid for 30 days from date of issue. RA number will be canceled after 30 days if not received. Any returns received without a valid number will be returned to you freight collect.
If this return is due to freight damage, it is your responsibility to first have the carrier inspect the material.
Toshiba will advise you of any damage incurred in shipment but will not be responsibility for repair costs associated with shipping damage or filling claims. No Work will be performed on equipment damaged in shipping pending your decision on filling a claim.
No collect shipments will be received. All freight, taxes, duties, fees, and bonds must be repaid to our facility.
You will be notified upon completion of "Work requested" and will have 10 working days to respond regarding disposition of the equipment. After 10 day the equipment will be returned to you and you will be billed for all associated costs. All equipment will be returned to UPS Ground or Truck unless otherwise specified.
An inspection charge will apply on all orders unless deemed warranty.

RA Form PDF File

REPAIR DEPARTMENT
RETURN AUTHORIZATION (RA) FORM

Please fill out the form below and submit. All items with * are required.

*Product Group Name

	Billing Information	Customer Information Ship To ( same as Billing Infomation)
*Company Name
* Address1
Address2
*City / State / Zip
*Contact Person
*Email Address
*Phone#
Fax#

UNIT / PART(S) RETURNED

*Type form/Model#		*Serial Number
Application		Job or Project#
Date Installed		Date Failed
Unit / Part was purchased from

Description (if parts only)	Part Number	Qty

*Description of Problem / Special Instructions: Please be specific. If no description is given a basic function test will be performed to check operation. You will be responsible for cost incurred:

Has the unit / part been replaced

Yes No

Sales order# for item being returned

Sales order# for replacement item

*PO# (Required)

Cost not to exceed

($100.00 minimum)

WORK REQUESTED

Warranty Evaluation	Repair and Return
Estimate Repair Cost	Other

For warranty evaluation model number, serial number, date installed and date failed must be provided.
IF DEEMED WARRANTY:
THE UNIT/PARTS WILL BE REPAIRED AND RETURNED, REPLACED OR CREDIT ISSUED TO CUSTOMER AT THE COMPANY'S DISCRETION.

IF WARRANTY IS DENIED...

Estimate Repair Cost	Scrap Part/Equipment
Return Unrepaired	Repair and Return

I would like this order expedited for an additional $150.00 Charge

*This order was authorized and requested by (Print Name)

Please check if you are a new Toshiba customer.

Please note: All orders and services are subject to credit approval. If you are a new customer, please print out a copy of this form from the 'Thank You' page after submission - or from your subsequent email verification/notification. Please sign the print-out by hand and fax to: for ASD and Drives (713) 896-5224 and for UPS Products (713) 896-5212. Any new account will be subject to credit approval.


10/22/03 Rev 8