Order Support Form

Customer ID:*

DEA Registration Number:*

If none, type N/A

Your GS1 Global Location Number:*

If none, type N/A

Delivery Date: *

Date

Number of Packages Affected:*

Today's Date: *

Date

Request Completed By: *

First NameLast Name

Reason for Order Support Request:*

If your request involves a return or credit, the information provided here will be used for evaluation purposes. Please note that submission does not guarantee approval. All applicable product integrity and compliance standards will apply.

Products Affected (if more than one - click add row): *

Upload Supporting Photo(s):*

If you are requesting a return or credit, any images provided will be used to support evaluation of the request. Submission of photos does not guarantee approval, and product integrity standards will still apply.

Authorized Signature: *

Your Email: *

example@example.com

Ongoing Assurance

Compliance & Shipping Declaration

(This form is subject to review and approval)

By submitting this Order Support Form and requesting assistance related to your order, you acknowledge and agree to the following provisions:

Product Origin & Responsibility
◦ The merchandise referenced in this form was originally purchased by the customer from Amatheon Animal Health.
◦ The customer is solely responsible for returning the product in accordance with the conditions set forth below, where applicable.

Packaging & Transit Requirements
◦ Any merchandise being returned must be shipped using the original or equivalent protective packaging materials in which it was received.
◦ Adequate protective materials (e.g., bubble wrap, packing peanuts) must be used to prevent in-transit damage.
◦ Refrigerated items must be returned in an appropriate cooler with frozen ice packs to maintain temperature stability.
◦ The customer assumes responsibility for ensuring that all merchandise arrives in acceptable condition. Amatheon will not issue credit for any items damaged in transit, improperly packaged, or otherwise compromised.

Storage, Handling & Compliance
◦ All merchandise returned must have been stored, handled, and shipped by the customer in accordance with:
▪ Applicable federal, state, and local laws
▪ Manufacturer’s handling and storage guidelines
▪ Good trade practices
◦ The product must not be adulterated within the meaning of the Federal Food, Drug, and Cosmetic Act, and must remain fully compliant with all FDA and applicable regulatory requirements.

Return Fees and Timeframes
◦ A $35 flat restocking fee applies to all authorized returns.
◦ For returns exceeding $250 in value, a 15% restocking fee will be applied.
◦ Products must be returned within 30 calendar days of the original purchase date.
◦ No returns will be accepted for expired medications.

Indemnification Clause
◦ The customer agrees to indemnify and defend Amatheon Animal Health against any claims, penalties, liabilities, or expenses (including reasonable legal fees) that arise from the customer’s failure to comply with the terms outlined herein.

Certification Statement
◦ Under penalty of perjury, I certify that I have read, understood, and agree to the above provisions, and that all information provided in this form is accurate and truthful to the best of my knowledge.

Return & Credit Evaluation Policy Disclosure
Amatheon Animal Health offers our customers a fair and structured process for evaluating requests involving credit or product adjustments. We are committed to correcting any verified shipping or order entry errors reported within three (3) business days of product receipt. If no notification is received within this window, the shipment is considered complete and accurate.

If your support request includes a return or credit inquiry, please note:
• All returns are subject to Amatheon's review and approval, and submission of this form does not guarantee a return or credit.
• Products must meet strict conditions regarding packaging, product integrity, and regulatory compliance.
• Returns must occur within 30 days of the purchase date and may only include unopened, undamaged cartons in original packaging.
• Returned items become the property of Amatheon upon acceptance at our facility.
Eligibility & Evaluation Guidelines
Credit may be issued at Amatheon’s sole discretion based on the following:
• 100% credit for saleable merchandise in original, sealed packaging with at least 9 months shelf life remaining.
• 80% credit for controlled substances (C3–C5) and certain special-order items.
• No credit for expired, near-expired, outdated, damaged, obsolete, or otherwise unsaleable items.
• Credit amounts for manufacturer-restricted items may vary in accordance with their return policies.

All returned merchandise must have been:
• Purchased directly from Amatheon in the normal course of business (not special-deal or non-returnable designations),
• Properly stored, handled, and shipped in full compliance with FDA, DSCSA, and other applicable federal/state regulations, and
• Acceptable for reintegration into the commercial marketplace based on Amatheon's internal quality and compliance review.
Amatheon reserves the right to decline any return that does not meet these criteria.

Restocking Fees
• A $35 restocking fee applies to returns under $250.
• A 15% restocking fee applies to returns over $250.

Definition of Saleable Product
A "Saleable Product" includes only those items that:
1. Remain in original, sealed packaging with no labeling alterations, damage, or third-party markings.
2. Have at least 9 months of shelf life (current month + 8 months).
3. Were stored and transported under manufacturer-specified and regulatory-compliant conditions.
4. Are not expired, seasonal, frozen, discontinued, drop-shipped, or otherwise restricted at time of return.
5. Were purchased from Amatheon directly and are eligible for return per our policies and applicable law.
6. Are, in Amatheon’s sole discretion, suitable for resale through standard distribution channels.

By submitting this form, you certify that the information and any supporting documentation provided are accurate and that any merchandise referenced complies with all applicable laws and storage/handling standards.

Amatheon provides our customers with a generous return policy for obtaining credit or adjustment for products sold by Amatheon. Amatheon will correct all order entry and shipping errors promptly upon notification from the customer in a timely manner.

Unless you notify Amatheon of any errors within THREE business days of your receipt of the products, the shipment is deemed to be correct. Amatheon will grant credit for returned products only if: (a) you contact Amatheon prior to the return and obtain our Return Goods Authorization (“RGA”), (b) return the product within 30 days of purchase, and return only unopened cartons. The amount of the credit shall be (a) 100% of the net purchase price for saleable products, (b) 80% of the net purchase price for controlled substances (C3 – C5) and special order products, (c) 0% for products unsuitable for resale because of age, obsolescence, expiration, or approaching expiration, and (d) a variable amount, if any, as determined by the manufacturer’s return policy for outdated and short-dated products.

All returned products (whether or not authorized) become Amatheon’s property. Returns over $500.00 will be charged a 15% restocking fee. Orders under $500.00 are subject to a $35.00 restocking fee. Products that Amatheon authorizes to be returned will be picked up by commercial carrier. You guarantee that the products listed on the “RGA” were properly stored, handled and shipped so as to not affect quality, and that the credit will not exceed the product’s actual purchase price.

“Saleable Product” means any Product that (i) is in original, full unopened packages with seals intact, (ii) is in original condition with no defects or adulteration in packaging or labeling and has no stickers or other marking not part of the manufacturer’s original packaging, (iii) has at least 9 months dating remaining before expiration (current month plus 8 months), (iv) was properly stored and transported while in Customer’s control and packaged properly for the return shipment to prevent damage in transit, (v) complies with manufacturer’s requirements to resell Product that has been returned, (vi) was purchased by you directly from Amatheon in the ordinary course of business (e.g., not a special transaction or other sale with returns restricted), (vii) is stocked at the distribution center at the time of the return and has not been discontinued, (viii) was not designated at time of purchase as “no recourse” or “not returnable,” drop shipment, special order, deals, pre-packs or a similar designation; (ix) is not seasonal or frozen; (x) is returnable and saleable under applicable laws and regulations at the time of return, and (xi) Amatheon determines in its sole discretion, Amatheon can sell back into the marketplace after a return in the normal course of business

Date:*

Number of Packages:*

Completed by*

Date*

Authorized Signature:*

Type in your products to return*

	NDC	Lot Number	Description	Quantity	Invoice
Item 1
Item 2
Item 3