Warranty
Name
*
Phone #
*
Email
*
example@example.com
Preferred Method of Communication from BalancePlus:
*
Email
Phone
BalancePlus Product & Description
*
Description of BalancePlus product (include gender, style, colour, size, etc)
0/30
Purchase Location
*
Name of store location where purchased
Date of Purchase
*
/
Month
/
Day
Year
Description of Issue
*
Please provide a brief description of issue with the product, please include how the issue occurred.
Proof of Purchase (receipt)
Product Picture
*
2nd Product Picture (if required)
Preview PDF
Submit
Should be Empty: