Return Goods Authorization Request
Please provide as much of the information asked
for below as possible so we can better assist you.
* fields marked with an asterisk are requested (highlighted in red)
*
Company Name
DBA
*
Customer #
Customer Contact
*
First Name
*
Last Name
Title
E-mail
*
Phone
Reason for Return
Select One
Customer Changed Mind
Ordered Incorrect Item
Did not receive item as ordered
Duplicate Order
Defective Item
Received Damaged Item
Other
Please provide one of the following pieces of information if possible:
Order Number
PO Number
Invoice Number
Are you returning all of the items on the invoice?
Yes
No
If "No" please list in the table below the items you are returning.
Product #
Quantity
Serial # (if applicable)
*If you need to list additional items please use the field below
Additional Notes:
Note: Completing and submitting this form does not guarantee that your request for return of goods will be authorized.
Please allow 2-3 business days for a customer service representative to contact you with further instructions.
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