RMA Request Form

* Required Fields
Contact Person*	Company / University Name *	Material(s) Reclaiming * (Name/Type/Weight or Size)
Address 1 *	Address 2	Material(s) Reclaiming * (Name/Type/Weight or Size)
City *	State *	HAZARDOUS MATERIAL CERTIFICATION
Zip / Postal Code *	Country *	List materials that contacted the returned item(s) *
Email Address *	Phone Number *	List materials that contacted the returned item(s) *
NOTE: ALL ITEMS RETURNED TO AJA INTERNATIONAL, INC. MUST BE THOROUGHLY CLEANED TO REMOVE ANY AND ALL HAZARDOUS OR TOXIC MATERIAL PRIOR TO SHIPMENT! AJA WILL TAKE MATERIAL SAMPLE FOR HAZMAT ANALYSIS After completing this form, use the email button below to send the Reclaim form to yourself. This form will need to be signed and emailed to AJA. (topgun@ajaint.com)		Full name of authorized representative *
		Title of authorized representative *