* = required fields

Customer ID#:

[ALST’s Permanent 6 digit code representing the company’s information.  To request your company code, please contact the Customer Service Team]

Name:*

Company Name:*

Company Address:*

State and Country:*

Telephone number:*

E-mail address:*
(A copy of this RMA Request will be forwarded to this address.)

Fax number:

Technical contact:

Technical contact Telephone number:

Technical e-mail address:

L-3 ALST Serial #:*

L-3 ALST Part #:*

L-3 ALST Revision #:

Customer Part #:

Customer Rev. #:

Customer Tracking #:*

[Any customer defined number used to track this RMA. ex: DMR#, CAR#, NCMR#, Quality Note]

U.S. Govt. Owned:*

[Please type: Yes, No or Unknown]

Dead on Arrival:*

[Please type: Yes, No or Unknown]

Select what type of failure:*

Please type the answer that best fits your failure:

if Other please state:

What set of operating conditions generates the failure (i.e. at a certain voltage, temperature, altitude, etc.)?

What tests were performed to confirm the failure?

Does the unit fail every time it is tested, or is the failure intermittent?

every time intermittent

Any comments, instructions or information that can
be provided to assist in isolating the
problem?

Customer P.O. #:*
(to be used to track this return)

[This field is used to track the customer PO# to this RMA#.  If no PO is currently available, please enter “N/A” ]

Did Customer cause the damage?:*

[Please type: Yes, No or Unknown]

Under Warranty:

Yes No Unknown

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