RMA Request

Please submit this completed form for all returns. We WILL NOT accept returned parts if they do not come with this form.

In order to complete this form, you must contact Kurt Hydraulics at hydraulicsales@kurt.com for an RMA # prior to submission.

"*" indicates required fields

RMA Number*

Customer PO

KURT Sales Order

Authorized By*

Company Name*

Contact*

Email Address*

Phone Number*

Fax Number

Customer Number

Return via

Invoice Number

Return Details

Items to Return*

Part No. to Return

Part No. Requested

Replace?

Quantity

Unit Price

Total Credit

Other Charges to Credit

Labor & Value Added

Freight Charge

Total*

Reason for Return*

Shipping error

Sales order entry error

Stock return

Customer purchase order error

Defective / Damaged

Other

Comments

Defective Parts Questionnaire

1. How did the product fail (installation or operating)?

2. Where is the failure on the assembly?

3. How long was the hose in service?

4. What was the operating temperature of application?

5. What was the pressure of the application?

6. Is manual handling of the hose required or is the hose a fixed application?

7. What crimping machine was used to assemble the coupling?

8. What was the crimp diameter and how was it located on the shell?

9. What is the lot number or date code on the parts and hose?

10. Were protective guards used in the application?

11. Are there any other details of the application that you feel are significant?

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Name

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