OEM Certified Product Repair Form

PLEASE NOTE: If you are using a credit card for your return, please do not enter the number in this form. A sales associate will contact you for the number. Thank you.

Billing Address

Company *

Address *

City *

State *

Zip

Contact *

Email *

Phone *

Fax

P.O. Number

Special Instructions

Is Shipping Address Same as Billing Address? *

Yes

Company *

Address *

City *

State *

Zip

Contact *

Part Number *

Quantity *

Date of Manufacture

Reason For Return *

Do you have a second part in need of repair?

Yes

Part Number *

Quantity *

Date of Manufacture

Reason For Return *

Do you have a third part in need of repair?

Yes

Part Number *

Quantity *

Date of Manufacture

Reason For Return *

Do you have a fourth part in need of repair?

Yes

Part Number *

Quantity *

Date of Manufacture

Reason For Return *

Do you have a fifth part in need of repair?

Yes

Part Number *

Quantity *

Date of Manufacture

Reason For Return *

You will receive an email confirmation from sales@oemcontrols.com
Please ensure sales@oemconrols.com is whitelisted in your email settings and you can receive emails from this address.
Thank you

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accepted-credit-cards