SRA Form for
LABGRUPPEN
Brand *
LABGRUPPEN
CHECKLIST
PLEASE DO NOT INCLUDE ACCESSORIES
(remote, power cord, mic, etc.)
PREFERRED CARRIERS
FEDEX or UPS
In Warranty?
In Warranty
Out of Warranty
Model *
--Select a Model--
120/1-70-US
C 5:4X-US
C-10:8X
C10-4X
C16-4-115E
C20-8X-US
C28:4
C28-4-115E
C28-4-230E
C48-4-115E
C68:4
C68-4-115E
C88-4-115E
CA1202
CA2402
D10
D10-4L
D120-4L
D20
D20:4L
D200:4L
D40
D40:4
D40-4L
D80-4L
E 10:4
E 5:4
E 8:2
E12-2
E2-2
E4-2
FP-10000Q
FP14000
FP2400Q
FP3400
FP-6000Q
FP7000
IPD1200-UK
IPD1200-US
IPD2400
LM44-US
LUCIA 120/ 1-70
Lucia 120/2-US
Lucia 240/2M-CN
Lucia 240/2-US
Lucia 240/I-70 US
LUCIA 60/2
Lucia240/2M-US
NLB60E
PLM10000Q
PLM10000Q-BP-115E
PLM12K44-SP
PLM14000
PLM20000Q
PLM20K44
PLM5K44
PLM5K44-U
Serial Number *
RMA Number
Purchase Date
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Select a State
Alberta
Alabama
Alaska
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
Newfoundland and Labrador
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Other
Zip *
Email Address *
Primary Phone *
Reason for Repair *
Original Box Notice:
Do NOT ship in original box/packaging. Your unit will be packed in a Panurgy box and returned to you.
Method of sending unit ?
DropOff
To Be Shipped
Method of return ?
PickUp
To Be Shipped
I have read the
Terms and Conditions