Manufacturers Rebate FormTrade-Up Program for Digital Repeaters, Active DAS Interface Trays (UDIT) & 4G Modems Instructions Please complete the form below. Upon submission of the form, Westell will reply with an RMA Number and return instructions via email within 3 business days. In order to expedite your rebate, please follow the return instructions carefully. Please note: You will be asked to email us a copy of your invoice for the items purchased. Once we receive the returned product and confirm the return meets the program requirements, your rebate will be processed within 30 days. Process Highlights: 1. Provide your contact information 2. List items purchased and related items to be returned 3. Read and click authorization acknowledgement 4. Click to submit rebate form New Rebate Form Contact InformationName* First Last Email* Company Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Items PurchasedPart NumberSerial NumberDate PurchasedPurchased From Items Being ReturnedPart NumberSerial NumberManufacturer Invoice* Questions? For questions regarding our current rebate offer, please email firstname.lastname@example.org or call (877) 844-4274. Authorization Acknowledgement Please read and check the box below indicating you are authorized on behalf your company to return the items listed above to Westell. You further agree in doing so that you surrender ownership of the items returned to Westell upon receipt and that the items will not be available for return. * I am authorized to return items on behalf of my company.