Partner/Customer Name:	Date:
Address:	Fike Partner/Cust. #
Contact:
Ship To Name:	Email:
Address:	Phone:
Qty.	Part #	Serial #	Item Description	Original PO#	*Action Code	**Routing (Internal)
1
Reason for Return:
2
Reason for Return:
3
Reason for Return:
4
Reason for Return:
NOTE: Electronic Modules MUST be packaged in anti-static packaging
* Action Code: A = Repair & Return B = Eval. For Return to Cust. C = Eval. For Restock (see below)	D = Eval. - Interact w/sales E = Advanced Replacement G = Refill (state agent)	H = Agent Quantity Modification R = Fike View AM Update	If for Five Year MRA Evaluation, Form FPS-WR must be included.
Project Name:	Shipping: Ground Next Day 2nd Day Best Way
Special Instructions:
Do not write below line (Fike use only):
Reviewed by:	Status:	Accepted	Rejected	Date:	MRA #:
** Fike Routing: E = Electronic, F = Fabrication, M = Mechanical Fill, ST = Finished Goods Stockroom, QY, QN
Fike Comments:

MRA Request & Shipping Instructions

Partner/Customer is to complete the Material Return Authorization (MRA) Request Form on the front of this document by filling in all the provided fields.

Partner/Customer emails the completed MRA Request Form to MRA@Fike.com.

Upon MRA Approval, Fike Customer Service will process the request and issue a Material Return Authorization (MRA) Number to the partner/customer.

Properly Package the return items for shipment.

SDS sheets (if required) must be attached to the outside of the shipping container.

The MRA Number provided by Fike must be clearly marked on the outside of the shipping container.

If drop shipping to Fike’s vendor, please follow provided instructions.

If returning to Fike, ship properly packaged returns using the following shipping label:

Fike Corporation 704 SW. 10th St. Blue Springs, MO 64015 Attn: MRA # ___________