9997 East Rose Hills Rd., Whittier, CA 90601 Tel (800) 876-8088 Fax (562) 908-8863 www.abspc.com ADVANCE REPLACEMENT FORM 1 PRODUCT INFORMATION * Part Description ABS SKU Number Serial Number * RMA Number 2 APPLICANT & SHIPPING INFORMATION * First Name * Last Name * Company Name * Address (1) Address (2) * City * State * Zip Code * Phone Number (1) Phone Number (2) * Fax Number * E-mail Address Applicant & Shipping Information could be left with blanks if it is the same as Billing Information. 3 BILLING INFORMATION * First Name * Last Name Company Name * Address (1) Address (2) * City * State * Zip Code * Phone Number (1) Phone Number (2) Fax Number E-mail Address Billing Information must be entered exactly as it appears on the credit card statement.
4 CREDIT CARD INFORMATION * Credit Card (MasterCard / Visa) * Card Number * Expiration Date * Authorized Signature Customer agrees that credit card number is to be used by ABS to secure the replacement.
Customer will only be billed for defective product not received within 10 days. Authorized Signature must be signed exactly as it appears on the credit card. Product will be shipped out by Federal Express 3-Day Service, if another shipping method is needed,
the customer will be responsible for providing payment for that service. NOTE: Items with a "*" are required