Repair Authorization Request

To submit a Repair Authorization (RA) request, please complete and sign the following form and email it to support@gidindustrial.com. If your request is approved, you will receive a reply with an RA # and instructions for shipping the merchandise to GID Industrial.

Client Information
Customer
Company Name	Address
Phone	Fax
Contact Person
Name	Phone	Email
Return Shipping Information
Company Name	Shipping Carrier	Collect Account #
Address	Special Shipping Instructions
Product Information
Please fill out the table below and add additional rows as needed.
Part/Model # Serial # or Quantity Description of Problem EXAMPLE-001 ABCDEFG123456 Unit does not POST.
Additional Questions
Have the boards been reworked previously?	Have customizations been performed on the boards?	Have the PCBs been physically damaged?	Could you provide a working board as a reference?	Could you provide a cable kit for the boards?
Describe the nature of the problem with the boards.

Payment Information
Payment Method
Please select a payment method below and provide associated information, if any:
☐ Credit Card ☐ Wire Transfer
Credit Card Information	Wire Transfer Information
Cardholder Name	Account Number	Bank Name	SWIFT Code
Branch Banking & Trust	BRBTUS33
Expiration Date (MM/YY)	Security Code (CVV)	Routing Number	Account Number
111017694	1440001903814
Billing Address	Address
5820 W Northwest Hwy Dallas, TX 75225-3201 USA
Terms and Conditions
The customer will pay GID Industrial the agreed-upon repair fee. All repairs are subject to a non-refundable USD $500.00 non-recurring engineering (NRE) deposit, per board, that is due at time of order confirmation. Work will not commence until GID Industrial receives the NRE deposit. If repair is needed, approved, and successful, the customer will pay GID Industrial the agreed-upon repair fee less the NRE deposit. GID Industrial will not proceed with repairs without quote confirmation from the customer. If repair is not needed, not approved, or not successful, there will be no additional repair fee; however, GID Industrial reserves the right to charge for return delivery. If the description of the problem is different from the problem listed by the customer on the RA request form, or if an item is damaged during delivery, GID Industrial will contact the customer for direction.
Signature
I agree to the terms and conditions set forth on this form.
Your Name	Date
GID Internal Use Only
RA #	Approved By	Date
Notes