Phytotronics RA Form RA Form Thank you for choosing Phytotronics® to repair your unit. Please complete this form, print and return with unit. Units to be repaired under warranty need to be returned with copy of receipt. ** Due to parts obsolescence, we are unable to repair the following 1626 models ** ** A, B, C, or D (120V) ** ** Due to parts obsolescence, we are unable to repair Gem2 (4 hour) or Gem6 (4 hour) ** Company Name Contact Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Daytime PhoneFaxEmail* Product InformationModel:Serial Number:Model:*Please provide a DETAILED description of the discrepancy.*We charge $95-340 to repair non-warranty Trident, 1626D with plug in transformer, Gemini 6A, Gemini 2A, 12A and Nova controllers. Please tell us your max amount willing to spend below. ($xxx.xx format)*RA InformationWe charge $95-340 to repair non-warranty Trident, 1626D with plug in transformer, Gemini 6A, Gemini 2A, 12A and Nova controllers. For Water Max, Mini Mist and Water Plus controllers we charge $215-265 to repair non-warranty units. For controllers which are inspected but are found to be working without issue, we charge $50. We assume no liability for units that are out of warranty. No refunds will be issued on non-warranty units that are determined, at our sole discretion, to be beyond repair. Any repairs made are warranted for a period of 90 days. The limitations described under the original limited warranty apply to any repair or replaced product, whether or not under warranty. As a service, we offer loaner units to our customers. Loaners are purchased up front at full price, but we cover the shipping to you via UPS Ground. When the loaner is returned in good condition, and working order, in a timely manner we will issue credit for the purchase, less a $50 processing fee. Any loaner kept for longer than 10 business days after receipt of repaired unit OR 45 days after shipment of loaner will be considered a final purchase, and no credit will be issued. To order a loaner, please call 314-770-0717. Phytotronics® will not pay any express shipping charges. The customer will pay any express shipping. Last pick up at 2:30 pm central standard time. It is recommended that the customer insure the unit being returned for repair. Phytotronics® does not assume any liability for items damaged in shipping. Please make a copy of this form for your records. Questions? Please call: 314-770-0717 or Email Cliff Hoogland at: email@example.com Please email tracking number when applicable (i.e. when using UPS or FEDEX) to: firstname.lastname@example.org Phytotronics® will accept a check or money order. Phytotronics® will also gladly accept payment by Visa, MC, or Discover. Payment can be made over the phone. Ship to address below. Phytotronics Repairs 13688 Rider Trail North Earth City, MO 63045CommentsThis field is for validation purposes and should be left unchanged.