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RMA REQUEST 1 - TYPE (Choose)
Circuit Board:		Fixture or Console:
	Logic/Main		Console/Controller
	Lamp Power Supply		Lighting Fixture
	Motor Power Supply		Optical Module
	Other (Describe Below)		Smoke/Fog Machine
Item description (make and model)		Serial Number:

Please explain problem or repair needs:

RMA REQUEST 2 - TYPE (Choose)
Circuit Board:		Fixture or Console:
	Logic/Main		Console/Controller
	Lamp Power Supply		Lighting Fixture
	Motor Power Supply		Optical Module
	Other (Describe Below)		Smoke/Fog Machine
Item description (make and model)		Serial Number:

Please explain problem or repair needs:

RMA REQUEST 3 - TYPE (Choose)
Circuit Board:		Fixture or Console:
	Logic/Main		Console/Controller
	Lamp Power Supply		Lighting Fixture
	Motor Power Supply		Optical Module
	Other (Describe Below)		Smoke/Fog Machine
Item description (make and model)		Serial Number:

Please explain problem or repair needs:

RMA REQUEST 4 - TYPE (Choose)
Circuit Board:		Fixture or Console:
	Logic/Main		Console/Controller
	Lamp Power Supply		Lighting Fixture
	Motor Power Supply		Optical Module
	Other (Describe Below)		Smoke/Fog Machine
Item description (make and model)		Serial Number:

Please explain problem or repair needs:

Pre-payment is required for all repairs. You are responsible for paying amounts associated with packaging items to be returned to you.

Repaired fixtures or boards that are with us longer than 30 days due to non-payment will become property of LightParts Inc.

Lightparts Inc. will charge your credit card noted below for repairs to your board/fixture/controller as noted, and necessary packing materials.

You will be notified if any repair is higher than $190.00 for boards and over $300.00 for fixtures & controllers. You otherwise agree that your card will be billed and agree to these terms.

LightParts labor rate: $95 per hour plus parts.

If no problems are found with you fixture or board, the fixture or board is D.O.A., or you choose not to proceed with repairs, your credit card will be charged a $50.00 Evaluation Fee (per item) + return shipping costs.

LightParts.com uses GeoTrust 256-bit SSL encryption to protect all of your private information on the internet. If you have any questions or are unsure about security, we offer a printable RMA request that you may fill out and fax to us. Click Here to request a fax.

Name on Credit Card:	Credit Card: Choose One VISA Master Card American Express
Address associated with card:	City/State/Zip:
Credit Card Number:
Confirmation Number (What is This?)
Expiration Date :	Choose Month January February March April May June July August September October November December Year 2011 2012 2013 2014 2015 2016 2017 2018 2019

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I hereby authorize LightParts Inc. to validate my credit card information and use this information to charge my final and agreed upon amount (if over the standard rates set forth above) when my repairs are complete.

I have also read the Terms & Conditions and RMA Service Requirements set forth by Lightparts and understand its repair, sales, warranty and return policies

	I have read and agree to the terms as listed above