Heartland

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

For Customers without a maintenance contract or equipment under warranty. 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:
Existing Customer:	Yes No		Customer Number:
If this equipment was purchased from Heartland within 100 days or within 1 year from manufacturer, then select YES, otherwise if unsure select NO.
Under Warranty :	Yes No		Warranty through:
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:	Problem Description:










Additional Information
PO Number:			* Required for T&M repairs.
Do you wish to add an expedite fee of $95.00 per each repair for faster turn-around (only applies to T&M repairs)
Yes, expedite my repair for an additional $95.00
No, don't expedite my repair for an additional $95.00
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

Click to verify BBB accreditation and to see a BBB report.


T&M RMA Request