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Please submit this completed form for All returns. We WILL NOT accept returned parts if they do not come with this form.

In order to complete this form, you must contact Kurt Hydraulics at for an RMA # prior to submission.

This return is valid through 2019-11-21.
Required Fields *
Enter Date: (YYYY-MM-DD)
RMA Number: *   
Customer PO:
Kurt Sales Order:
Authorized by: *   
Company Name: *   
Contact: *   
E-Mail Address: *   
Telephone Number: *   
Fax Number:
Customer Number:
Invoice Number:
Return via:
Return Details (Min of one part number required.)
Part No. to return Part No. requested Replace? Quantity Unit Price Total Credit

yes no

yes no
yes no
yes no
Other charges to credit:
Labor & value added:

Freight Charge
Reason for Return *
       Shipping error
   Sales order entry error
   Stock Return
   Customer purchase order error
   Defective / Damaged
Defective Parts Questionnaire
1. How did the product fail
(installation or operating)?
2. Where is the failure on the assembly?
3. How long was the hose in service?
4. What was the operating temperature
of application?
5. What was the pressure of the application?
6. Is manual handling of the hose
required or is the hose a fixed application?
7. What crimping machine was used
to assemble the coupling?
8. What was the crimp diameter and how was
it located on the shell?
9. What is the lot number or date code
on the parts and hose?
10. Were protective guards used
in the application?
11. Are there any other details of the
application that you feel are significant?
Validation Code *