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?
YesNo

Is there visible physical damage?
YesNo

If yes, please describe:

Is the product functioning at all?
YesNo

If yes, describe what still works:

Have troubleshooting steps been attempted?
YesNo

If yes, please describe steps taken and outcomes:

Have you contacted technical support before?
YesNo

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

Type of Request:
ReturnReplacement

Is the product under warranty?
YesNoUnsure

Was the issue present upon delivery?
YesNo

Is the product opened?
YesNo

Is the product in original packaging?
YesNo