STORE details
Store Name
*
Blundstone Account Number
*
Claim submitted by
*
Contact Phone Number
*
Format: 0000-000-000.
Contact Email Address
*
Store Address
*
ADDRESS MUST BE WITHIN AUSTRALIA TO PROCEED
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CUSTOMER DETAILS
Customer Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: 0000-000-000.
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PRODUCT & CLAIM details
Style Number
*
Size
*
Purchase Date
*
-
Month
-
Day
Year
Date customer purchased from store
Number of days worn
*
Blundstone Invoice Number/Store PO
*
Country of Manufacture
*
Located inside the boot on the tongue or tab attached to the elastic side
Primary Use
*
Work
Leisure
General
Areas of Discomfort (select all that apply)
*
Ankle
Heel
Arch
Forepart
Toe
Other (add details below)
Please explain reason for discomfort
*
Please add any additional information relevant to the wearers discomfort
Top Photo
*
Upload top photo
Drag and drop files here
Choose a file
Attach a photo of the top of your boots (left & right boot).
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of
Side Photo
*
Upload profile photo
Drag and drop files here
Choose a file
Attached a photo of the profile of your boots (left & right boot).
Cancel
of
Sole Photo
*
Upload sole photo
Drag and drop files here
Choose a file
Attached a photo of the soles of your boots (left & right boot).
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of
Date Stamp/Size Dial Photo
*
Upload date stamp photo
Drag and drop files here
Choose a file
Cancel
of
Customer Requested Solution
*
Please Select
Exchanged for another Blundstone Style
Exchanged a different Brand of Footwear
Full refund given to customer
What Style
*
What Brand
*
Please verify that you are human
*
Submit
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