Reseller RMA Request

(All fields are required.)


Reseller Customer Information

First Name
Last Name
Address
City
State
Zip Code
Telephone
Company Name
E-mail
Date Purchased

Product Information

(1) PNY Part Number, Quantity, Distributor, Invoice/PO# (Example: FD128GB345XP, 3, Ingram Micro, Invoice #567890)
(2) PNY Part Number, Quantity, Distributor, Invoice/PO# (Optional)
(3) PNY Part Number, Quantity, Distributor, Invoice/PO# (Optional)
(4) PNY Part Number, Quantity, Distributor, Invoice/PO# (Optional)
Problem/Failure Description
Troubleshooting/Resolution Steps