Night Vision Systems, a DRS Technologies Company is based in PA with Engineering and Manufacturing located in AZ.

Please take time to complete this form in full. Items marked with an asterisk are required items. Failure to complete these items will result in not getting a Return Material Authorization (RMA).

*First Name:

*Last Name:

*Company:

Billing Information

*Address 1:

Address 2:

*City:

*State/Province:

*Zip Code:

*Country:

*Phone:

Fax:

*Email:

Your PO Number:

Shipping Information

Check here if your shipping address is the same as your billing address.

First Name:

Last Name:

Company:

Address 1:

Address 2:

City:

State/Province:

Zip Code:

Country:

Phone:

Fax:

Email:

Product Information

*Product Type/Description:

Product Model Designation:

Product Serial Number:

Production Date (if known)

Contract purchased under (if known)

Length of Time in Your Possession

Approximate Usage Amount

Weapon Mounted?

Weapon Type

If not weapon mounted, specify use

Type of Claim

Check one of the following:

Estimate required before repair (Evaluation Fee)

Warranty Claim

Problem Definition

Please describe the nature of the problem experienced with the product:

Please describe the activity you were engaged in when you first encountered the problem described above:

What is the best way to contact you?

Phone

Additional Information and Instructions

Upon receipt of the above information a Night Vision Systems representative will reply back with a RMA (Return Material Authorization) Number for your return and shipping instructions. Please do not ship back your product before receipt of a RMA number.