United Micro Return Authorization Form

Return Authorization Form for Replacement

This is a request for a Return Authorization Number. You will be contacted within
24-72 Hours VIA Email with such a number. If any questions arise you may be
contacted by telephone. If you have purchased a Complete Computer System
Please Call 1-800-943-7255 to request Authorization Return.

Name :

Invoice Number :

Phone No:

Invoice Date (MM/DD/YYYY) :

Email Address :

Return SHIP TO Address :

Item(s) Information :

Part Number(s) for Item(s) :

Serial Number :

Reason for Return :

Defective Product

Wrong Product

Incompatiable with existing Hardware

Problem Description :