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Statement of New and Unused Equipment
1) Return Material Authorization (RMA) Number:
Equipment Identification
2) For each instrument being returned, list a description or model number and its serial number.
Description or Model Number Serial number
3) Reason for return:
Shipping Requirements
4) Clearly mark RMA number and “NEW AND UNUSED” on each shipping package.
5) Include one copy of this document inside the original shipping package, and attach one copy to the outside of each package in a
visible location.
6) Ship all equipment to: Address correspondence to:
Attn: RMA# _____________
Micro Motion Inc.
C/O Veolia Environmental Services
Sensor Department
9131 East 96 Avenue
Henderson CO 80640 USA
Micro Motion, Inc.
7070 Winchester Circle
Boulder CO 80301 USA
Attn: Repairs
Definition and Restock Fees
Only equipment that has not been removed from the original shipping package will be considered new and unused. New and
unused equipment includes sensors, transmitters, or peripheral devices which:
• Were shipped as requested by the customer but are not needed, or
• Were shipped incorrectly by Micro Motion.
Restock fees might apply, depending on the reason for return:
• If the customer ordered the wrong equipment, a restock fee will be charged.
• If the customer no longer requires the equipment (for example, if a project was cancelled), a restock fee will be
charged.
• If Micro Motion shipped the wrong equipment, a restock fee will not be charged.
THIS EQUIPMENT IS BEING RETURNED AS “NEW AND UNUSED,” PER THE DEFINITION STATED ABOVE.
I UNDERSTAND A RESTOCK FEE MIGHT BE CHARGED.
By:
(Signature) (Print name)
Title: Date:
Company:
Phone: Fax: