ATLEX.COM RETURN REQUEST

Date of RMA/ISSUE request:

Customer or Company Name:

Email Address:

Order Number
(only one order number per request - use multiple requests if necessary)

TYPE OF RETURN/ISSUE
(please read all choices and select the one that applies

What items would you like to return:
(enter item(s) and qty)

Reason for Return:
(ie. printer no longer works, ordered incorrect item, etc)


What items were received in error?
(enter item(s) and quantity)


Is/Are the Item(s) open?
(Yes or No)


What items were NOT received?
(enter items and quantity)


What items were NOT received?
(enter item(s) and quantity)

What items were damaged?
(enter item(s) and quantity)

Please describe damage?
(enter type of damage - smashed, not enough, or lack of packaging, etc)

Please indicate carrier and tracking number of damaged shipment:

Did you place a NEW order for replacement?
(Yes or No - If yes please list Order Number)

Please indicate defective items(s) being returned for exchange:
(enter item(s) and quantity)

Please describe defect (bad chip, etc.):

Please indicate defective item(s):
(enter item(s) and quantity)

Please describe defect (bad chip, etc.):

Image verification To submit this form, please enter the characters you see in the image: