WRGA Defective Return

Your First Name*

Your Last Name*

Your Email*

Date of Form Submission*

Company Name*

Branch*

Original Serial # (Only required for Lochinvar, Modine, and Skidmore return requests)

Replacement serial # (Only required for Lochinvar, Modine, and Skidmore return requests)

Original Model #*

Replacement Model #*

Original PO #*

Replacement PO #*

Original Invoice #*

Replacement Invoice #*

Install Date*

Failure Date*

Installation Type*

Quantity*

Part*

Date Code*

Reason for Return*

Quantity

Part

Date Code

Reason for Return

Quantity

Part

Date Code

Reason for Return

Debit Memo #

Notes

Click below to upload debit memo, pictures or other documentation. File types accepted: PDF, JPG, PNG

Drop files here or

Max. file size: 2 GB.

All returns are subject to review and approval.
A copy of this form will be emailed to the email address provided on this form.
All returned product must be accompanied by a copy of the emailed form with WRGA #; any returns sent back without prior approval are subject to denial.
Material is to be returned, pre-paid, to B.J. Terroni Company’s warehouse: 3190 Tucker Road, Bensalem, PA 19020, unless otherwise indicated.
Freight charges for the shipment of returned product(s) are the returning company’s responsibility.
Credit for freight charges will not be given, debits for freight will not be accepted; deductions of any kind will not be accepted.
If a replacement is provided for the returned product, it can be picked up at B.J. Terroni Company’s warehouse or shipped directly; freight will be charged.

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