Warranty Request Form

Please fill in the information below, and one of our technical support team members will contact you as soon as possible.

You can also print form and fax to: 937-525-3101.

Name

Company

Phone

IDENTIFYING INFORMATION (REQUIRED) IDENTIFYING INFORMATION (REQUIRED) R&M/Stagemaker Order Number Customer PO Number Model No./Serial Number

Insert Identifying Number Here

Quantity (REQUIRED)

Parts Number (REQUIRED)

Reason For Request (REQUIRED)

REPLACEMENT PARTS SHIPPING INFO REPLACEMENT PARTS SHIPPING INFO Standard freight = paid by R&M Expedited freight = paid by others

Shipper Company (REQUIRED)

Address Line 1 (REQUIRED)

Address Line 2

City (REQUIRED)

State/Province

Zip/Postal Code (REQUIRED)

Country (REQUIRED)

(REQUIRED) (REQUIRED) TERMS & CONDITIONS: I have read and understood Contact Data Protection Statement. Customer Contact Data Protection Description and Cookie statement.

Number