RGA Form

RETURNS FORM:

Complete the following for any returns
Customer Name *

First Name Last Name
Company *
E-mail *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Contact Number *

Area Code Phone Number
Please indicate reason for return... *
Product Type: *

Standard Item Non-Standard Item Private Label
Please indicate ITEM # ((i.e. AFLEX-20W-0350-D-G)
ITEM DESCRIPTION: *
(i.e. AFLEX 20W 120VAC-277VAC 3 VDC-57VDC 350mA Logarithmic Dim Curve D enclosure)
Number of Units: *
Quantity being returned
Multiple Part Entries - (please use the spreadsheet below for multiple part entries)
Invoice #:
if available
Invoice Date / Purchase Date:
ITEM CONDITION

Non-Defective* Defective
Thank you for completing your RGA Form. Once received, one of our customer support team members will contact you.
Please verify that you are human *
Should be Empty:

RETURNS FORM: