To Be Filled out by Jotron AS

RMA Request

Customer no. at Jotron AS (if available) Click here to enter text. Support Agreement ref.no if any Click here to enter text. Customer name Click here to enter text. Main office address Click here to enter text. Delivery address Click here to enter text.

Reference number Claim no / Hull no / PO no for repair etc. Reference name Project name / Vessel name / Enduser etc. Contact person Click here to enter text. Contact person e-mail Click here to enter text.

Reason for return: Click here to enter text.

Select return category: Click here (Drop down list)

EQUIPMENT Item no / Product Name / Module type Individ/Serial no Fault description

Click here to enter text. Click here to enter text. Click here to enter text.

If possible please inform originally purchase order no/Jotron Sales Order no: Click here to enter text. Date / Filled in by : Click here to enter text.

To be filled out by Jotron AS: ☐ RMA not approved, further information will follow. ☐ RMA NO : Click here to enter text. ☐ Please return equipment to below address, mark the box and documents with the RMA NO. ☐ ☐ Jotron AS Jotron AS Østbyveien 1 Innlaget 230 NO-3280 Tjodalyng, Norway NO-3185 Skoppum, Norway Attn: Repair/ RMA14….. Attn: Repair/ RMA14…..

Completed request can be e-mailed to: [email protected]