Service Return Portal

(RMA) Return Material Authorization

Complete all required fields to generate a clean, review-ready return package.

RMA Request

Core authorization information for this return record.

RMA Number Authorized By Authorization Date Date Received

Customer Details

Commercial and shipping information provided by the customer.

Customer PO Number Contact Name Customer Company Name Phone / Fax / Email Delivery Date

Sold-to Address

Ship-to Address

Emerson Internal Details

Internal references and receiving-side contact block.

Original Order No. Invoice No. Invoice Date Currency

Product Group

Has the equipment been installed? Yes No

Attention Company Name Phone Email Address

Return Item Details

Use one form per returned item to keep the case traceable.

Serial Number

Model Number (MATRIX) HTS

Reason for Return

Application Details and Decontamination

Declaration and contact details for safe receiving and handling.

Hereby certified that the equipment being returned has been cleaned and decontaminated in accordance with good industrial practices and is in compliance with the COSHH regulations and any other relevant health and safety regulations. This equipment poses no health or safety risks due to contamination.

Items under warranty are tested on arrival. If no issue is found, a processing fee of $195 per item may apply.

Company Name Contact Name Department Date Phone Number Fax Number Email Address Signature

Created By Avraham Avniloff