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RMA Request Form

Return material authorization (RMA) number(s) can be obtained by completing the following online request form. Use this form whether you purchased a product from Immersion, an authorized reseller, or another party. For medical simulation products, contact Immersion Medical using the medical technical support inquiry form.

After the RMA form has been received and reviewed, we will respond within two business days with either an RMA number and instructions for returning the product or with a request for additional information if necessary. Return authorizations are not automatically guaranteed by submission of this form.

Multiple products may not be combined under a single RMA number. Each covered product must be returned separately under its own RMA. Products returned without a valid RMA number clearly marked on the package will not be accepted.

For additional questions and answers regarding warranties and RMAs, please contact your customer service representative.

All fields with a red asterisk ( * ) must be filled out in order to submit the form.


 

Customer Contact Information

   Name (First / Last):*

   E-mail Address:*

   Reseller / Company:*

   Phone:*

   Fax:*
 
Ship To Address
   Street 1:*
   Street 2:
   City:*
   State/Province:*  Other:
   Country:*
   Postal Code:*
   
Bill To Address* Same as Ship To Address
   Street 1:
   Street 2:
   City:
   State/Province: Other:
   Country:
   Postal Code:
   
Return Unit Information
   Product:*
   Purchase Order#
   Part #
   Serial # *
   Is product under warranty?
  Yes     No    Don't know
 
   Who did you purchase this product from? [Please select one and provide name if applicable.]
  Immersion
  Reseller
  Other
 
Description of problem:*
 

   

 

 

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