USMS RMA Form

View RMA Instruction
RMA Form 2
* Required
US Medical Systems
Attn: Repairs
3535 Centre Circle
Fort Mill, SC 29715
-------------------------
Contact Information
Date *
MM
/
DD
/
YYYY
Facility Name *
Your answer
Department *
Your answer
Contact Name *
Your answer
Contact Phone Number *
Your answer
Contact Email *
Your answer
Confirm Contact Email *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Choose
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code *
Your answer
Purchase Order Number *
Your answer
Please Check the Box to Request a Shipping Label *
Required
Equipment Needing Repair
Equipment Category *
Required
Quantity (Item 1) *
Your answer
Enter Manufacturer, Model, Serial Number, and Description of Issue (Item 1) *
Your answer
Quantity (Item 2)
Your answer
Enter Manufacturer, Model, Serial Number, and Description of Issue (Item 2)
Your answer
Quantity (Item 3)
Your answer
Enter Manufacturer, Model, Serial Number, and Description of Issue (Item 3)
Your answer
Quantity (Item 4)
Your answer
Enter Manufacturer, Model, Serial Number, and Description of Issue (Item 4)
Your answer
Quantity (Item 5)
Your answer
Enter Manufacturer, Model, Serial Number, and Description of Issue (Item 5)
Your answer
Get updates, alerts and special offers from US Medical Systems *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service
Google Forms
 
 

HOURS
MON-FRI: 8:00am-5:00pm
SAT & SUN: Closed