Customer Repair Return Form

Name
Address
City
State / Province / Region
Phone Number
Email
Preferred Contact Method EmailPhone
Product Place of Purchase
Received as a GiftYesNo
Reason For Return

PRE- AUTHORIZATION:
If your item is not covered under warranty, but you still want to have the required repairs done, do you hereby authorize repairs costing up to $50.00? (In the unlikely event that the cost of repair exceeds $50.00, we will contact you for authorization. Product w/o repair authorization will be returned after 30 days)
YesNo

PRODUCT RETURN/REPLACEMENT OPTION:
If your returned warrantable item cannot be repaired for whatever reason, would you accept an equivalent replacement item or would you want the original item returned to you in an "as is" condition at no additional cost?
ReplaceReturn

Sign