Repair request USA

1. State *

2. Email address of the person raising the Repair RMA *

3. Full name of the person raising the Repair RMA *

4. Since this is a repair , which of the following are you considered to be ? *

Please select one of the following:

Distributor

Health care professional

Student

5. Your organisation/ company name *

6. Address line 1 (no PO boxes please) *

7. Address line 2

8. City *

9. Zip code *

My shipping address is different than company address

10. Phone number *

11. Please select product range *

12.Select from product *

13.Product part number

14. Serial number - If product does not have a serial number add N/A *

Only 1 instrument per request, if you have more than one please add another request

15. Customer account number

if known?

16.Purchase order number

17.Date of purchase

18.Product warranty *

In warranty

Out of warranty

Unknown

19.Did your product fail during use? *

Yes

20. Please describe the issue you are experiencing ? *

21.Accessories included?

Yes

22.Is the proof of purchase available ? *

i.e. images, pictures, x-rays, scans, videos or any other supporting documentation.

Yes

• Important! Keeler cannot be held responsible for equipment that is damaged or lost in shipping.
Therefore, we strongly advise that you follow these instructions carefully.

• Instructions

Please complete the form above and click 'Submit Form'.
Print the repair returns label and affix to the box.
Select a carrier that provides tracking information for the package.
Securely pack and ship the product.
Please use either UPS or Federal Express to send the package back to us.

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