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Account Number *

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Phone Number *

Fax Number

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Order Date

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All discrepancies must be reported within 5 days of receipt of goods. Please clearly indicate the problem with the product by selecting the appropriate code. Returns will not be accepted for in store damage or overstocked merchandise. If your claim requires a physical return, a Customer Service Specialist will contact you within 5 business days to arrange a return call tag. Returns sent back without prior Customer Service authorization may be refused and credit may not be issued.

Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

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Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

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Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

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Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

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Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

Click here to add more items

Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

Click here to add more items

Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

Click here to add more items

Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment *

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

Click here to add more items

Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment *

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

Click here to add more items

Item Number *

Item Description *

Quantity *

Claim Reason *

General Comment *

Quality Issue Details *

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error? *

How many items did you receive in error? *

Upload photos of damages, if applicable

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