Return Authorization Form
Please type or print clearly. Complete all fields and enclose with your return.
Name: ______________________________________________________ Date:_______________
Original Invoice #:___________________________ Address: ____________________________
City: ____________________________________________________________ State: __________
ZIP:__________
Telephone: _______________________________________________ Fax_____________________
Email address:___________________________________
Product Number/s:______________________________________________________________________
Quantity:_________________
Reason for return:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
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Request replacement product: Yes _____ No _____ RA #:_____________________
Please include credit card information used for your initial order, if you are requesting a refund.
Name on card: ______________________________________________________ Type of card: __________________
Credit card account number:______________________________________________ Exp. Date: __________________
Ship to:
Returns processed within 48 hours after receipt.