Return Material Authorization (RMA) Form

Type of Return (check all that apply): *
Is the equipment damaged/defective?: *
***CONTACT NGES FOR WARRANTY REPAIR***
Has the product been opened or used?: *
***RETURN AUTHORIZATION WILL NOT BE GRANTED FOR OPENED CONTAINER PRODUCTS (INCLUDING PARTIAL CASES)***
Is the chemistry over 30 days from delivery date?: *
Has approval been obtained?: *

***APPROVAL MUST BE OBTAINED FOR CHEMICAL PRIOR TO RETURN***
 
PLEASE COMPLETE THE QUESTIONS BELOW AND AN APPROVAL REQUEST WILL BE GENERATED TO THE APPROVER

Sales Information

Requestor: *
Order Type: *
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Could this return have been prevented by any of the following?: *
 
Has the product already been opened?: *
Can this product be used at a nearby location?: *

Customer Information

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Return Information

Is Pick-up Address Different Than Original Delivery?: *

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CHEMICAL

Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *
Add Another Product?
Shipping Unit of Measure: *
Was Correct Product Shipped?: *
Type of Return: *
Is Product Hazardous?: *
Does Shipment Require Hazmat Placards?: *

EQUIPMENT

Unit of Measure:
Add Another Product?
Unit of Measure:
Add Another Product?
Unit of Measure:
Add Another Product?
Unit of Measure:
Add Another Product?
Unit of Measure:

Order Information

Return Reason due to Off Spec Material --> Please complete a Case Management incident and provide the Case Management number below.
Do you have the original invoice number?: *
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Suggested Credit Amount Method: *
If restocking fee is applied, who is responsible for the cost?: *
Minimum 25% restocking fee will be applied.