Lentech Automatics Original Invoice # : Purchase date # : Date of return# : RMA # :

RETURNED MERCHANDISE AUTHORIZATION (RMA) FORM To undertake the process of Merchandise Return, you need prior authorization from Lentech. First, call the Technical inquiries line at : 613-838-5390 Identify your purchase, and make a verbal "problem report" to the Lentech representative If agreement is reached for merchandise return, Lentech will issue an RMA number to you, which MUST be clearly marked on this form prior to shipment. Print and complete the form in detail, affix the signature of the original purchaser (if a VISA purchase, then this is the cardholder's signature),and then fax the signed and completed form to Lentech at : 613-838-3265 Remove all personal modifications from product (eg. lines, fittings, mounts) and drain ALL fluids. Re-package or re-crate securely the merchandise to be returned, and affix the RMA form in a VISIBLE location on the OUTSIDE of the packaging All returns from within the US. must be sent (freight prepaid) to: Lentech Automatics, 800 Proctor Ave, Ogdensburg, NY, 13669, U.S.A. All returns from within Canada or other countries must be sent (freight prepaid) to: Lentech Automatics, 3835 McBean St, Richmond, ONT, K0A 2Z0 CANADA

NAME : ADDRESS : PHONE : PRODUCT TYPE : PAYMENT METHOD (VISA,MC,CHEQUE) : PROBLEM REPORT : I the undersigned hereby agree to return this product to Lentech Automatics for repairs and not refund. I also agree that Lentech Automatics thereby incurs no costs other than the repair of their products under warranty. NAME OF ORIGINAL PURCHASER : SIGNATURE OF ORIGINAL PURCHASER :