RMA request for a product from Mirai
 customer data
Type of address :
Private Business
company :
first name contact person :
last name contact person :
address :
Zip Code / City :   
phone :
cellphone :
fax :
email :
alternative email :
preferred contact method :
fax email mail
 hardware data
type of monitor :
brand name :
serial number :
example : n/a
where purchased? :
date of purchase :
Please pick a fault description :
Comments to the fault :
your reference :
is this a complaint
to a previous repair?
Yes No
                                                
! IMPORTANT ! In order to take care of your rma request we need to have a copy of the receipt.
 Please note down the reference number on the copy of the receipt and enclose it to the device.