RMA Request Form : Halogen Transformer : Powerselectinc.com

RMA Request Form
Please use this form to request an RMA for one or more PowerSelect products. To avoid possible delays in processing your request, please make sure the form is filled out as completely as possible. If you have any questions regarding our products, please contact us and we will get back to you as soon as possible.

Name:

Title:

Email:

Website:

Company:

Company Type:

Contractor
Distributor
End User
OEM

Address 1:

Address 2:

City:

State:

Zip:

Phone:

Fax:

Other:

Comments/Questions:

Fixture Type:

Desk Lamp
Floor Lamp
Indoor
Outdoor
Landscape
Recessed Downlight (In ceiling)
Sign Light
Surface Mount Ceiling Fixture
Track Light
Under Cabinet
Wall Mounted Fixture
Other

Is a sample of the fixture available?:

Yes
No

Fixture manufacturer:

Fixture model:

Lamp type:

Has the unit been hot spot tested?:

Yes
No

PowerSelect model number(s):

Quantity of units in question:

Total units:

Product date code(s):

Installation date:

Type of failure:

Name and address of Installation:

Hours of operation at location: