RMA/Service Request Form
Thank you for inquiring about servicing your equipment with Cal Coast Ophthalmic Instruments, Inc. This form is to coordinate RMA/Repair/Service requests and return merchandise authorization (RMA). Please fill out this RMA/Service request form, and you will receive an email with your RMA or Service Call number and/or further information regarding your request within one business day.
Customer Account #
Customer Company Name
First Name
Last Name
Email
Is a PO # Required?
Yes
No
PO#
Was the instrument purchased through Cal Coast?
Yes
No
Are you sending something in to be repaired, requesting service at your location, or returning a product?
Sending something in
Requesting service
Returning a product
Service Address
Customer Bill to Address (If Different from Service Address)
Equipment Make
Request Service Report?
Yes
No
Equipment Model
Serial Number (SN)
Request Loaner?
Yes
No
Reason for Return/Repair/Service
Please provide a picture if applicable.
Select a File
Submit