B2B Customer Return Request Form

Contact Name

Email Address

Phone Number

Return Shipping Address

Model Number

Serial Number

Product Name

Date of Purchase

Purchased From

Purchase Order Number (optional)

Has the product been used?
[radio* product-used use_label_element "Yes" "No"]

Is there visible physical damage?
[radio* physical-damage id:physical-damage use_label_element "Yes" "No"]

If yes, please describe:

Is the product functioning at all?
[radio* is-functioning id:is-functioning use_label_element "Yes" "No"]

If yes, describe what still works:

Have troubleshooting steps been attempted?
[radio* troubleshooting id:troubleshooting use_label_element "Yes" "No"]

If yes, please describe steps taken and outcomes:

Have you contacted technical support before?
[radio* contacted-support id:contacted-support use_label_element "Yes" "No"]

If yes, provide support ticket number(s) or representative name:

Type of Request:
ReturnReplacement

Is the product under warranty?
[radio* under-warranty use_label_element "Yes" "No" "Unsure"]

Was the issue present upon delivery?
[radio* issue-on-delivery use_label_element "Yes" "No"]

Is the product opened?
[radio* is-opened use_label_element "Yes" "No"]

Is the product in original packaging?
[radio* in-packaging use_label_element "Yes" "No"]