Return Material Authorization Form

Company Name *

Enter the name of your company.

Date *

Select the date of the request.

Attention to *

Enter the name of the person to contact.

Email Address *

Enter your email address.

Return Shipment Details

Ship-to address eMagin should use after processing the RMA.

Address Line 1 *

Address Line 2

City *

State / Province *

Postal / Zip Code *

Country *

Telephone Number *

Note: In order for eMagin to process your request for a return we need the information below to be provided prior to issuing an RMA number. Please attach supporting files (e.g. non-conformance reports or display photos).

Return Information *

Fill in at least one row. Serial Number and Defect Description are required for each row used.

Supporting Files (optional)

Upload photos, reports, or other supporting documents.