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Ship to: Imagin Systems Corporation
517 Marine View Ave. #H
Belmont, CA 94002
RMA# & Date
Imagin Use only
Dental Office
Doctor's Name
Last Name
Contact
Street Address
City
State
Postal/Zip code
Street Address Line 2
Country
Country
Office Phone
Cell
Fax
Email
ITEM DESCRIPTION FOR REPAIR: SHIPPING INSTRUCTIONS:
X-RAY SENSOR
I/O CAMERA
IOS 3D CAMERA
OTHER
Brand
PLEASE SELECT A RETURN SHIPPING SPEED,
UPS
GROUND
IS STANDARD IF LEFT BLANK
1-DAY
2-DAY
3-DAY
Model
Serial Number
Shipping Insurance
Tell us what is happening to the best of your ability
Imaging Software used (i.e. Eaglesoft, Dexis, VixWin, Apteryx) List accessories ingluded:
USB CABLE
ATTACHMENTS
SOFTWARE-DISC/THMB DRV.
PC
MAC
PRINT THIS FORM NOW BEFORE SUBMITTING IT!
TYPE
CTRL - P
TO PRINT
Make Sure You Put a Copy of this Form in the Shipping Box!
Please Read the Following Conditions Carefully:
• Please take care when packaging your items to prevent damage in transit.
• All repairs will be given a 90-day limited warranty for parts and labor unless otherwise stated on the quotation provided. Equipment left over 90 days will be scrapped & we aren’t responsible for them after that point.
• If an Item is unrepairable a $50 return shipping/handling fee will need to be made to receive items back.
• Please include the amount of insurance you want on return shipping; we are not responsible for lost items. Roughly estimated $1000 insurance
equals $10.00 of additional shipping cost. All Shipments without stated Insurance will automatically have $1000 insurance added.
By Submitting this Form, You Understand the Conditions Above
SUBMIT THIS FORM
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SHIPPING INSTRUCTIONS
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