Full Name

*

Title

Company

Address

*

City

*

State / Province

*

Zip / Postal Code

*

Phone

FAX

EMail

*

Purchased From  * Date Purchased  *

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.

Items for which a return Authorization is being requested

*Item 1

Quantity

Part #

Color

Color N/A White Black Beige Gray Taupe Custom *

Reason for Return Request of item 1

Item 2

Quantity

Part #

Color

Color N/A White Black Beige Gray Taupe Custom

Reason for Return Request of item 2:

Reason for Return Request of item 3

Item 4

Quantity

Part #

Color

Color N/A White Black Beige Gray Taupe Custom

Reason for Return Request of item 4

Item 5

Quantity

Part #

Color

Color N/A White Black Beige Gray Taupe Custom

Reason for Return Request of item 5

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.