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RETURN AUTHORIZATION FORM |
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Click to submit directly to Customer Care |
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Account/Order information |
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Account #: |
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Request Date: |
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Account Name: |
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Original Order #: |
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Return Request Generated By: (First, Last Name) |
PO #: |
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Contact phone: |
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Return Authorization reply preference: |
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Email confirmation requested: (Enter email) |
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Fax confirmation requested: (Enter fax #) |
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Return Information |
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Quantity |
Part Number |
Description |
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Return Reason |
Lot/Manuf # |
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If this return meets the DJO qualifications for supplying a prepaid return label (ARS tag) tag Indicate quantity of return tags and tag delivery method (email/fax) in the comments section below. If the return is quality related, please include the Lot/Manufacturing code for each item.
Comments
V 1.0 2/15/2013
