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Multipix RMA Number

RMA Request Date *

Product(s) and Serial Number(s) *

One per line

Company Name *

Contact Name *

Phone *

Email *

Reason for RMA request *

Select...FaultyRefundDamagedOther

Where applicable please complete the system configuration when the problem occurs.

Operating System & service packs

Framegrabber manufacturer & model

Framegrabber manufacturer's software & version

Camera manufacturer & model

Camera manufacturer's software & version

Other software used to demonstrate product failure

Other relevant system information

Has the product worked previously?

Yes

No

What are the changes from the last known working configuration? *

If possible, when the product is swapped for a new one, does the new product work?

Yes

No

N/A

What is the serial number of the working product?

Fault Description *

Please provide a full description of the problem including any error messages and sequence of events to when the fault occurs.

Damage Description *

Please provide details of damage

Refund *

Please give details of reason for refund

Other *

Please give details

File Upload

Please attach any associated screen shots or images to demonstrate any problems

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