Returned merchandise authorization

Review the details below. Some fields cannot be edited.

Stop if this is an adverse event

If this return is due to an adverse event (per CFR 21 part 803.1) that caused, may have caused, or contributed to death
or serious injury, do not continue with this RMA. Call us immediately.

713-723-6900

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Phone

Address

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State

City

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Quick add items

	Item Number	Invoice or PO Number	Date of Invoice	Quantity

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Notes

If all items on the request have the same reason for return/repair, please select it here:

	Item number, description		Invoice or PO Number	Date of invoice	Quantity

Please note that you will receive an RMA number for the items that are being returned, and a separate RMA number for items that are sent for repair

Acknowledgment

Approve this repair nowWe`ll start as soon as the items arrive.

Send a quote firstReview pricing before any work begins.

Repair PO number

I, acknowledge that credits/exchanges will only be issued for products returning in perfect and unused condition. Returning merchandise past 30 days due are subject to a restocking fee*

I approve this exchange, my PO# is*

I, acknowledge that credits/exchanges will only be issued for products returning in perfect and unused condition. Returning merchandise past 30 days due are subject to a restocking fee*

Returning instruments for credit

No returns on used or altered instruments

Return instruments in their original packaging with tip guards. We can`t accept used, damaged, blemished, custom-made, custom-etched, discontinued, or altered products.

Address the package clearly, and include the RMA number and your return address.
Attach this completed form and the packing slip to the outside of every container, and keep a copy for your records.

By typing my name below, I acknowledge that any used, damaged, blemished, custom-made, custom-etched, discontinued, or altered products returned for credit will not be accepted and will be returned to the sender.

Signed by (full name)

Title

Sterilization & decontamination

Federal handling rules require every used surgical instrument to be sterilized before it ships. Declare the status of each item below.

Returning instruments for credit

Used instruments must be sterilized before shipment to Wexler

Under CFR 29, Part 1910.1030, shipping used, unsterilized reusable medical devices is unlawful. Any that arrive unsterilized are quarantined and disposed of immediately - their value is lost, no refund is issued, and trial units remain billable.

Sterilize any product used in a procedure or on cadavers before shipping.
Print this completed form and attach it to the outside of every shipping container.
Deliveries without a completed RMA form won`t be accepted.

Item	Qty	Sterilization status	Reason for return

Signed by (full name)

Title

Sign & complete

After submission, your RMA request will be reviewed. The status of your request and RMA number, if approved, will be sent by the next business day via the email provided.

Returns sent without an RMA number will not be accepted.

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Signed by â€”

Make sure to click the "Submit quick add items"
button to add these items to your RMA

Instrument type

Specialty

Procedure set

Product Series

Product line

Returned merchandise authorization

Stop if this is an adverse event

Quick add items

Line items

Please note that you will receive an RMA number for the items that are being returned, and a separate RMA number for items that are sent for repair

Acknowledgment

Returning instruments for credit

No returns on used or altered instruments

Sterilization & decontamination

Returning instruments for credit

Used instruments must be sterilized before shipment to Wexler

Sign & complete

Fields with * are required