Return Authorization Request Form

Returns Authorization Request Form
By submitting this Returns Authorization Request Form, you acknowledge that you have read and understood Auburn's Returns Policy.

Individual Initiating Return*

First NameLast Name
Company Name*
Auburn Account Number*
Please enter your Auburn Pharmaceutical Account Number here.
Customer Email*
Customer Phone Number*
Please enter a valid phone number.
Customer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please fill in all of the information related to your return.*

	NDC or Item No.	Product Description	Size	Invoice #	Invoice Date	Lot #	Price Paid	# of Bottles/Tubes/Boxes being returned	Reason for Return	AUBURN INTERNAL
Item #1
Item #2
Item #3
Item #4
Item #5

Please use this space to provide any additional information and/or comments:*

I acknowledge that the product(s) being returned was purchased from Auburn Pharmaceutical and that the product(s) was(were) stored under appropriate conditions of temperature, humidity, and light. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated here are true.
Signature of Individual Initiating Return*

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