Return Materials Authorization
Van London Co.

ASSIGNMENT OF AN RMA DOES NOT GUARANTEE CREDIT OR REPLACEMENT

Date:	(MM/DD/YYYY)
Customer Name:
Contact Email:	(A copy of the data submitted in this form will be e-mailed to this address)
Contact Phone Number:
RMA # Assigned:
VLC Invoice # / your P.O. #:

Cleaning method used (including cleaning agents) to render these items safe to handle.

* If you picked "Other" as a reason for return or Probe Exposure, please explain. Please provide all information that is relevant to this failure.

Please complete the following if the probes were used:

Type of Application

Do you prefer:

Special shipping instructions:

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