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Please provide the following contact / buyer information: |
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| * Full Name |
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| Title |
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| Company |
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* Address |
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* City |
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* State / Province: |
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* ZIP / Postal Code |
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| * Phone |
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| FAX |
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| * E-mail |
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| Please provide the following information about the items you wish to return: | ||||||
| * Purchased From * Date Purchased | ||||||
| (DEALER, DISTRIBUTOR or RETAILER NAME) | ||||||
| * Invoice Number | ||||||
| NOTE: UPON COMPLETION OF THIS FORM, A COPY OF THE DISTRIBUTOR OR DEALER'S INVOICE MUST BE SENT BY FAX TO: 305-251-8826, OR AS A SCANNED ATTACHMENT BY EMAIL TO: sales@saftron.com IF PURCHASE WAS NOT MADE DIRECTLY FROM SAFTRON. | ||||||
| Items for which a return Authorization is being requested | ||||||
| *Item 1 | Quantity | *Part # | *Color | |||
| Reason for Return Request of item 1 | ||||||
| Item 2 | Quantity | Part # | Color | |||
| Reason for Return Request of item 2: | ||||||
| Item 3 | Quantity | Part # | Color | |||
| Reason for Return Request of item 3 | ||||||
| Item 4 | Quantity | Part # | Color | |||
| Reason for Return Request of item 4 | ||||||
| Item 5 | Quantity | Part # | Color | |||
| Reason for Return Request of item 5 |
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| Additional Comments: | ||||||
I certify that I am the purchaser of the above listed product(s) for which this return authorization is being requested; that I have read and understand SAFTRON's product warranty and that the declarations I have made are true and correct to the best of my knowledge. |
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