Heartland

NOTE: This request and correspondence is via email, if you do not have an email address please call Heartland to request an RMA.

For Customers with a maintenance contract, please make sure your information is complete. Items with asterisks represent required inputs. If you have any questions please call Heartland Computers main office at 866-708-7222

RA Information
Customer PO#:			Date:
Contract Number:			Customer Number:
Billing Information
* First Name:
* Last Name:
* E-Mail:			Copy of this form will be sent to this address
* Company:			* Denotes required fields
* Address:

* City:
* State:			* Zip:
* Phone:			Extension:
* Fax:
Shipping information (Check to use Billing Information: )
First Name:
Last Name:
E-Mail:
Company:
Address 1:
Address 2:
City:
State:			Zip:
Phone:			Extension:
Fax:
Equipment Information
Manufacturer:	Model:		S/N or Asset #:	Problem Description:










Additional Information
PO Number:		For abused/damaged equipment only.
Shipping method:		Contract Customers will be billed for additional shipping charges above and beyond Ground service.
Comments:	Enter your comments here
Please make sure your information is complete. Items with asterisks represent required inputs. If you have any questions please call Heartland Computers main office at: 866-708-7222

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Contract RMA Request