Empire Distributors Maintenance Contract Repair

Default Shipping Address:

Please ship device(s) to alternate address.

By default all units will be returned to:
Empire Distributors Inc
685 Hartman Rd
Austell, GA 30168-7765

Attn:

Please enter the name of the person the shipment should be returned to.

Return Repaired Terminals To:

Street Address Address Line 2 City State ZIP Code

Email

Phone

Date

CONTRACT INFORMATION

CONTRACT #: SI20000047
EFFECTIVE DATE: 9/9/20-9/8/23
MODEL #: CK75
SERIAL #'S COVERED UNDER THIS AGREEMENT: 17193D8131, 18058D80DD, 18058D80DF, 18058D80EA 18058D80F4, 18058D810E, 18058D8128, 18058D813A 18058D813B, 18058D813E, 18058D8148, 18058D8149 18058D814F, 18058D8157, 18058D815F, 18058D8160 18058D816B, 18058D8171, 18058D8191, 18058D8196 18059D81AF, 18058D80D7, 18058D8100, 18058D810D 18058D8129, 18058D812E, 18058D8133, 18058D8137 18058D8147, 18058D814B, 18058D8156, 18058D815C 18058D8164, 18058D816A, 18058D816F, 18058D8178 17227D812D, 17227D817D, 17227D81D5, 17228D8093 17228D80B6, 17228D80C6, 17228D8124, 17228D8131 17228D81AB, 17228D81B2, 18231D8053, 18231D8071 18231D81CA, 18232D8066, 18232D807B, 18232D807F 18232D80EB, 18232D80F6, 18232D81C2, 18232D81EB 17268d8024, 17268d8050, 17268d801e, 17268d8040 17268d8028, 17232D803B, 17268d803c, 17268d8042 17268d804e, 17268d8054, 17268d801d, 17268d88011

Serial Number

Problem With Unit

Do You Have Another Unit To Return?

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No

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Do You Have A Third Unit To Return?

Yes
No

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Do You Have A Fourth Unit To Return?

Yes
No

Serial Number

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Do You Have A Fifth Unit To Return?

Yes
No

Serial Number

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Do You Have A Sixth Unit To Return?

Yes
No

Serial Number

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Do You Have A Seventh Unit To Return?

Yes
No

Serial Number

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Do You Have An Eighth Unit To Return?

Yes
No

Serial Number

Problem With Unit

Do You Have A Ninth Unit To Return?

Yes
No

Serial Number

Problem With Unit

NOTE: RMA NUMBER should be written on the outside of all shipping containers.

A copy of this form will be emailed to you upon completion. Include a copy of the form in the box that you are shipping. Please ship via insured carrier. POSDATA is not responsible for damage incurred during shipment to repair facility.

Empire Distributors Contract RMA

CONTRACT INFORMATION

POSDATA GROUP, INC. HQ

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