|
RMA
Type (please check one):
[ ] Return
for exchange
[ ] Return for refund
[ ] Return for in-store credit
[ ] Return for
repair/replacement
[ ] Advanced replacement/return |
|
For
Office Use
Only
RMA # issued:
Date issued:
By whom: |
|
Name:
Shipping Address:
[ ] Return for exchange
[ ] Return for refund
[ ] Return for in-store credit
[ ] Return for
repair/replacement
[ ] Advanced replacement/return |
Order Number:
Contact Name:
Email:
Telephone:
Fax: |
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Part Number |
Qty |
Date of Purchase |
Condition |
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Line 1 |
|
|
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[ ] Unopened,
sealed in
original packaging
[ ] Opened |
| Reason for
Return:
Describe Condition: |
|
Line 2 |
|
|
|
[ ] Unopened,
sealed in
original packaging
[ ] Opened |
| Reason for
Return:
Describe Condition: |
|
Line 3 |
|
|
|
[ ] Unopened,
sealed in
original packaging
[ ] Opened |
| Reason for
Return:
Describe Condition: |
|
Line 4 |
|
|
|
[ ] Unopened,
sealed in
original packaging
[ ] Opened |
| Reason for
Return:
Describe Condition: |
|
|
|
If for an exchange,
please indicate items desired below |
| |
Part Number |
Qty |
Price per Item |
Subtotal |
|
Line 1 |
|
|
|
|
Description:
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Line 2 |
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Description:
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Line 3 |
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Description:
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Line 4 |
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Description:
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Name:
Shipping Address:
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CC#:
Expiration Date:
Billing Address:
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I have read, understood and agree to be bound by the
Terms and Conditions of Sale (see http://discountinkjetcartridges.com/dc_shop/terms.htm
[link]) and the Return Policy currently in
effect (see http://www.discountinkjetcartridges.com/return_policy.htm [link]).
Your request must be signed and faxed
to (503) 643-5379 or mailed to the address above and we will process it. A
response will be emailed to you. It is the responsibility of the customer to
ensure receipt of this form by DiscountInkjetCartridges.com.
