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Customer Return Authorization

Consultant Name
First Name Last Name
Customer Name*
First Name Last Name
Purchase Date*
Month Day Year
Item requesting return on*
Reason for return*

Like new with in 30 days Manufacturer Defect / Item under $50 with in 30 days Manufacturer Defect / Item OVER $50 with in 6 months
Action requested*

Replacement with same item Replacement with alternative item Repair of item
If Replacement requested / which item would you like?
Upload receipt copy
E-mail*
Phone Number
- Area Code Phone Number
Should be Empty:

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