L-3 EOTech Holographic Weapons Systems

Returning a Product for Repair

Return Authorization Request Form

Please fill out the form below. All fields with an asterisk (*) are required.

First Name*

Middle

Last Name*

Company* Address (line 1)* Address (line 2) City* State* ZIP Code* Phone* Email* Model Number*:

If "other", please describe button location, battery type, and if nv button is present in comments.

Quantity*: Serial Number*:

Note: Serial number and Manufacture Date decals located on sight base.

Manufacture Date (mm/yyyy)*: Description of Failure* RA# Issued by Repair & Service:

(L3 EOTech will assign upon completion)

Cost (If Applicable)*: I prefer to be contacted by: Comments Security Question:

How many dots are in this reticle image?

This Holographic Weapon Sight must be exported from the United States in accordance with Export Administration Regulations ECCN 0A987. Diversion contrary to U.S. law is prohibited. In accordance with U.S. law (Title 15 CFR part 746 and Supplement No. 1 to Part 774; and Title 31 CFR) resale/re-export or transfer of Holographic Weapon Sight Models 552, 551, 512, 511, 4X magnifier and 3X magnifier to certain designated countries is prohibited without prior written consent of the U.S. Department of Commerce. The Holographic Weapon Sight Models 553, 557 and 555 are controlled under U.S. International Traffic in Arms Regulations (ITAR) and may not be exported without proper authorization by the U.S. Department of State.