RMA Request

Please complete the form and click submit at the bottom of the page. A copy will be emailed to the address provided.

Your unique RMA number will be displayed once the form is submitted. It will also be included in the email you will receive. Please use this number when communicating with Select Biomedical about your repair.

Thank you!

"*" indicates required fields

RMA#

Company Name:*

Date

Ship to:

Attention:*

Address:*

Street Address Address Line 2 City State ZIP Code

Bill to:

Company Name:

Attention:

Address:

Same as Ship to Address

Street Address Address Line 2 City State ZIP Code

Contact Name:*

Phone Number:

Email:*

Email 2:

To add an additional email address, enter it here.

Email 3:

To add an additional email address, enter it here.

Email 4:

To add an additional email address, enter it here.

Email 5:

To add an additional email address, enter it here.

Item(s) being shipped for repair:

Your Reference or PO #:

(Required before order will ship)

Comments:

(Please include any special requirements)

Expedited Repair Option (Only valid if box is checked)

Repair orders can be expedited on a 48 hour turnaround from receipt of equipment (not including return shipping time). This service will be offered for a 30% up charge of the original repair cost and will be returned to you via UPS Next Day Saver, (additional charge).

Yes, expedite my order

Phone

This field is for validation purposes and should be left unchanged.

Submit an RMA Request

Advanced Exchange Request

866.559.3500
952.897.3500

Ship to:

Bill to:

Item(s) being shipped for repair:

Submit an RMA Request

Advanced Exchange Request

866.559.3500
952.897.3500

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Edina, MN 55439

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