Account #:
Your Name :
Are all of the items in their original packaging and in resalable condition?
Yes No
NOTE: Have more than one invoice number? Submit an additional request!
Invoice #:
Today's Date:  <%= Date() %>
Invoice Date:
example: (6/11/2007)
All items must be returned within 10 days from date of original invoice.
Please call Customer Service for assistance…972-424-8561,
if your invoice date is beyond the 10 days.
Quantity Item # Description