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Return Material Authorization Request

The * indicates a required information to process your order. Make a note of the RMA Number on this form and refer to it when you talk to our Service Representative. Also, be sure to hit the “Submit” button at the bottom of this form for FASI to process it.

*RMA #: *Name: *Company: *Address: Address2: *City: *State: *Zip Code: *eMail: *Phone:

Model ID:

What are your returning?

Select your return type Scanners Processors Z-Mike or Zygo

Scanners

Model Number Select Scanner Model # Not Sure 50-03 60-03 61-050 79-00 100-050 101-100 102-195 135-325 135A-325 135CV 136-325 140-1300 160 161-040 162-100 163-100 164-01 179-550 179CV 180-750 200 (all models) 201 202 263-195 280-1950 500 501-195 600-00 LD1075 LD1100 PM195 RJR-1 for FLM 101 Beta LD Single Axis Beta LD Dual Axis Beta LN Single Axis Beta LN Dual Axis

Serial Number Problem Description

Comments: Special Shipping Instructions:

Processors

Model Number Select Processor Model # Not Sure 50 60 79 82-00 83 85 182 183-00 183-04 183-100 183-195 183-325 183-550 183A-00 183A-04 183A-100 183A-195 183A-325 183A-550 183B-00 183B-04 183B-100 183B-195 183B-325 183B-550 183W 183DD 192 (w/o DSP) 192-14 192-17 192-27 282 (all versions) 382 500 600 700 800 810 820 860 900 Series (all versions) 1000 Series (all versions) 2000 Series (all versions) 1150F 12 13 53 54 59 89 360 410 411 489 3560 6000 6001 6050 6100 6201 6301 6401

Serial Number Problem Description

Comments: Special Shipping Instructions:

Z-Mike or Zygo

BenchMike Type Select Type Not Sure Z-Mike Zygo

Serial Number Problem Description

Comments: Special Shipping Instructions: