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Company Name:

Name:

Email:

Address:

Customer PO#:

Reason for RMA (please check one):
Domestic RMA:

Purchased from Nivisys and under warranty. (Product to be shipped in on the sending parties account. Nivisys will ship product back to sender on Nivisys’ account)

Purchased from Nivisys and not under warranty.(Non-Warranted Items billed $95.00 per unit Evaluation Fee)
Not purhased from Nivisys Repair (Non-Warranted Items billed $95.00 per unit Evaluation Fee)

International RMA:

Purchased from Nivisys and under warranty. DSP-5. (Product to be shipped in on the sending parties account. Nivisys will ship product back to sender on Nivisys’ account)

Purchased from Nivisys and not under warranty.DSP-5. (Non-Warranted Items billed $95.00 per unit Evaluation Fee)

Demo Return to have repaired or replaced. DSP-73

Product Details

Item:	Part Number:	Description:	Serial No:	Qty:
1
	Describe Unit Defects:

+ Add Item

The hardware and/or data supplied in connection with this transmission, including Purchase Order and/or Request for Quotation, may be subject to export control under the jurisdiction of either the International Traffic in Arms Regulations, 22 CFR 120-130 (ITAR) or the Export Administration Regulations, 15 CFR Parts 730-774 (EAR). The disclosure or transfer of this hardware and/or technical data to foreign person(s) may require written export authorization granted by the Directorate of Defense Trade Control (DDTC) or the Bureau of Industry Security (BIS) in the form of an export license, a technical assistance agreement, or the use of an applicable exemption or exception. The Supplier is not allowed to export the hardware and/or technical data provided by Nivisys, LLC without prior written approval from Nivisys LLC's Export Compliance Officer. Diversion contrary to U.S. law is prohibited. Violations are punishable by both civil and criminal penalties, which may be severe. Nivisys,LLC is ISO 9001 certified.

915-633-8354

Combat Night Vision Systems

RETURN MATERIAL AUTHORIZATION FORM

Reason for RMA (please check one):
Domestic RMA:

International RMA:

Product Details

915-633-8354

Combat Night Vision Systems

RETURN MATERIAL AUTHORIZATION FORM

Reason for RMA (please check one):Domestic RMA:

International RMA:

Product Details

Reason for RMA (please check one):
Domestic RMA: