M    E    G    A           M   O   T   O   R        U   S   A
2827 88th Avenue NE | Bellevue | WA | 98004 | USA

RETURN MATERIALS AUTHORIZATION FORM | RMA NUMBER:_________

Please attach a copy of your sales receipt to the back of this form.  Is this equipment under Warranty?

YES_____ NO_____

Has this equipment ever been returned for the same problem? 

YES_____  NO______ 

Payment Method: 

Visa _____ MC _____ Discover _____ American Express _____ PayPal _____ 

Credit Card or Account Number: _____________________________  EXP Date _____/_____  CSC: _______

Packaging List: 

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Please explain in detail what is wrong with your product: 

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Signature:_________________________     Date:_{_________________________}