Retailer - Return Authorisation Form

RMA Request - Retailer/Reseller

Customer Number/ Account Code:

You can find your account code on our invoice. Sample copy!

*If you are from Harvey Norman Store. Please go to Harvey Norman - RMA Form
If you do not have your customer code, please contact accounts@laserco.com.au for customer code

Customer Information

Company Name*:
Contact Person*:
Street*
Suburb*:
State*
Postcode*:
Telephone No*:		Fax Number*:
Email Address:*
Confirm Email*:
Your Reference Number/Credit Claim No.*:

Request Item(s)

LASER Product code Qty Fault Description Invoice No Invoice Date Your Item Reference Item Batch No (optional)
click here for a sample batch no

If you cannot see above text clearly, click here to change text.

Please enter Verification code shows above *: