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Modine Warranty Form
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Modine Return Material Authorization
All Returned Material Must Be:
1) Properly Labeled
2) Packaged To Withstand Normal Hazars of Transportation and
3) To Be Shipped
Return Type
Other
_____________________________________________________________________________________
Modine Reserves The Right To Perform Destructive Tests And Dispose Of Material Returned For Analysis
_____________________________________________________________________________________
Customer Name *
City *
State *
Customer Reference Number
Modine Order #
Replacement or Original Invoice #
Customer Acct. #
Rep Code
Note: please do not use 'defective' as reason for return.
Material Returned For
Reason for Return
Installation Name & Address
Name
Street
City
State
Zip code
Date Installed
Date Removed/Failed
Please enter the unit serial number below if this section is filled.
Material To Be Returned By
Name
Street
City.
State.
Send R.M.A. To (Name & Address)
Name.
Street.
City.
State.
Zip code.
Fax Number
e-mail Address
_____________________________________________________________________________
Quantity
Complete Unit Model Number
Unit Serial Number
Part Name/Description
Part Model No. (if available)
Part Serial No. (if available)
Material Disposition
Issued By *
Date
Return to
R.M.A. Void After
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Phone: 316 263-8179 or 800 835-1010, Fax: 316 263-2040 or 800 835-1150
224 Indiana,    Wichita,  Ks   67214
8:00 AM to 5:30 PM M-F,  8:00-Noon on Saturday,  Closed on Sundays and Holidays.
Tempstar Distributor for Kansas

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