Return Authorization Request

Please complete this form, print it out, put it
with your machine and send it to SAMM.
(LASER REPAIRS - PLEASE CALL FOR RA)


First: Last:

Company:

Address:

City: State: Zip:

Phone: Fax:

Product:
Serial #:

Dealer Purchase Order Number:
RA No.  will be assigned when we receive the product
We take AMEX, VISA and MASTERCARD (Circle One)
Card No:
Expiration Date:

Description of Complaint




SHIPPING ADDRESS:
SAMM, Inc.
5655 Bear Lane, Suite 102
Corpus Christi, TX 78405
Phone: (361) 289-2215