NOTE - Due to delinquent payments on accounts with our company, we have been forced to only accept *COD, CREDIT CARD or CHECK in Advance TERMS. We are sorry for this change made in our accounting system.

PO #'s are as stated on the RMA Form:" Purchase Order Numbers are for your reference only and not for payment Terms. "

*COD will add $9.00 to amount !! Visit us On-Line for your Clinical Needs !!
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PLEASE NOTE NEW ADDRESS:
ClockWork Innovative Solutions, Inc.
8419 Oak View Drive,
Chattanooga, TN 37421
1-888-562-2990 Fax: 423-855-0710
E-Mail: clockwork@chattanoogaservice.com

 RMA Request Form
RMA#

Tennessee Tax on Repairs Guidelines - PDF Document
 

Bill To Address

   Ship To Address
Check to use Billing Information:
Company Name (required)
Company Name (required)
Address (required)
Address (required)
  City (required)
  City (required)
State (required)
State (required)
Zip (required)

Zip (required)
  Unit Make (required)
  Purchase Order#(PO Number for your reference only*)
  Model# (required)
  Estimate (required)

  Serial# (required)
  Shipping Method

  Phone# (required) xxx-xxx-xxxx

   Fax# xxx-xxx-xxxx
  E-mail

Contact Name (required)


   Accounts Payable Name & Phone # (required)
 

Accessories With Unit
Leads QTY:

  
Please tell us if you are including a line cord.
  Pads QTY:
   Applicator(s)
  # Red # Black # Other
   # 2cm # 5 cm # 10cm
  Other Accesories
  Complaint with unit (required)
 
  Date Received (MM/DD/YYYY)
PLEASE DO NOT TRY TO PRINT THIS PAG E
Please click the button below to process your RMA. The next page that appears will be printable.





CAUTION! ClockWork is not responsible for damage in shipping when received. Do not pack in foam Peanuts/Popcorn for this is used as a filler only and will shift during shipment
and allow damage to your product. Make sure contents are secured firmly and padded well on all four sides with at least 2 to 3 inches of padding.
*Purchase Orders are for your reference only. ClockWork can not accept POs as a method of payment.
Please Note! ClockWork Innovative Solutions, Inc has relocated to new facilities at:
8419 Oak View Drive Chattanooga, TN 37421 Our phone numbers remain the same