Laser Copier Cartridges .com RMA Request Form

RMA Request Form

Date Received:
By Whom:

RMA Type (check one):

[ ] Return for in-store credit

[ ] Return for refund

[ ] Return for exchange

[ ] Return for repair/replacement

[ ] Advanced replacement/return

Please fill in all fields below, as applicable:

Order Number:
Name:
Shipping Address:	Billing Address:
Telephone Number:
Fax Number:
Email Address:

Line #	Part #	Qty	Describe Condition
1			[ ] Unopened, sealed in original packaging [ ] Opened
	Reason for return:
2			[ ] Unopened, sealed in original packaging [ ] Opened
	Reason for return:
3			[ ] Unopened, sealed in original packaging [ ] Opened
	Reason for return:
4			[ ] Unopened, sealed in original packaging [ ] Opened
	Reason for return:

If for exchange, please fill in desired items below:

Part #

Description

Qty

Price

Shipping Information:

Billing Information:

I have read, understood and agree to be bound by the Terms and Conditions of Sale (see http://lasercopiercartridges.com/terms.htm [link]) and the Return Policy (see http://lasercopiercartridges.com/returns.htm [link]) currently in effect.

Your form must be signed and faxed to (503) 643-5379 or mailed to the address above and we will process it. A response will be emailed to you. It is the responsibility of the customer to ensure receipt of this form by Laser Copier Cartridges .com.

Signed:_____________________________________________ Date:___________________

Name (please print):________________________________ Company:_________________

Terms and Conditions of Sale
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Laser Copier Cartridges .com is not affiliated with any OEM manufacturers. All manufacturer names and logos are
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