Product Return Form

Lastname (required)

Firstname (required)

Your Email (required)

Contact Number (required)

Customer Account Number

Customer Invoice Number/ Order Number (required)

Product Part Number (required)

Product Serial Number (required)

Product Description (required)

Quantity (required)

Has the package been opened? (required)

YesNo

Error Record: (Please select one of the below options)

—Please choose an option—Customer ErrorRep ErrorSupplier ErrorFaulty

Reason For Return/ Fault Description (required)

Action Required (required)

Acceptable File Format: PDF, JPEG, PNG: (Maximum 10MB)

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