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Terms and Conditions

Appendix F

Embedded and Industrial Computing

RMA Service Request Form

When requesting RMA service, please fill out the following form. Without

this form enclosed, your RMA cannot be processed.

RMA No:

Reasons to Return: Ŀ Repair(Please include failure details)

Ŀ Testing Purpose

Company: Contact Person:

Phone No. Purchased Date:

Fax No.: Applied Date:

Return Shipping Address:

Shipping by: Ŀ Air Freight Ŀ Sea Ŀ Express ___

Ŀ Others:________________

Item Model Name Serial Number Configuration

Item Problem Code Failure Status

*Problem Code:

01:D.O.A.

02: Second Time

R.M.A.

03: CMOS Data Lost

04: FDC Fail

05: HDC Fail

06: Bad Slot

07: BIOS Problem

08: Keyboard Controller Fail

09: Cache RMA Problem

10: Memory Socket Bad

11: Hang Up Software

12: Out Look Damage

13: SCSI

14: LPT Port

15: PS2

16: LAN

17: COM Port

18: Watchdog Timer

19: DIO

20: Buzzer

21: Shut Down

22: Panel Fail

23: CRT Fail

24: Others (Pls specify)

Request Party

Confirmed By Supplier

Authorized Signature / Date Authorized Signature / Date

1 2 ... 47 48 49 50 51 52

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