Mid Atlantic Data Systems, Inc. 845D Quince Orchard Boulevard, Gaithersburg, MD 20878 Voice: (301) 590-0666, FAX: (301) 417-9737 R M A   F O R M Required Fields in Red Primary contact made via fax. Allow 48 hours (M-F) for processing & contact Invoice Number  (Mid-Atlantic Invoice numbers are 4 digits long.) Serial Number  (if applicable) Date Of Purchase  (mm/dd/ccyy) Company  Address Line #1  Address Line #2  City/State/Zip  ,     Contact  ,  Phone  FAX  Email Address  Product  Quanity  Part #  (On Invoice) Product/Component is  Defective Wrong Item No Longer Required Wrong Item Ordered See Below Describe Problem  Please indicate how you would like to resolve these issues. (Fix/Replace/Refund/Repair/Credit) Resolve  Please print and fax to 301-417-9737