This form is used to initate a computer hardware repair. Please fill out this form as completely as possible. The required fields are in orange and indicated by a [ * ]. If you have any questions on our RMA process, please e-mail rma@asiweb.com.

First Name*
Last Name*
Company*
Street
City
State	Select... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY International
Zip
Country
E-mail
Phone*
Fax
Is the product under warranty? *	Yes No
Product Manufacturer*	(i.e. Compaq, IBM, Wyse)
Product Type*	Printer Terminal PC Other
Model Number	(if any)
Personal ID Number	(if any)
Serial Number*	This number will be found on the actual unit you are having repaired.
Date of Purchase	Required for Warranty Service
Where Purchased	Required for Warranty Service
Shipping*	Ship to 14637 West 95th Street (KC location)
Description of Problem*
Additional Comments
	Thank you for using our on-line RMA form. If you have any suggestions on how we can improve this form, please e-mail us.