Return Authorization Request Form

Company Information

Company Name (required)

Customer Name (required)

Your Email (required)

Your Phone Number (required)

Send copy to optional email (optional)


Item 1: Product Information

Manufacturer Part Number (required)

Quantity (required)

Serial Number


Item 2: Product Information

Manufacturer Part Number

Quantity

Serial Number


Item 3: Product Information

Manufacturer Part Number

Quantity

Serial Number


Item 4: Product Information

Manufacturer Part Number

Quantity

Serial Number


Item 5: Product Information

Manufacturer Part Number

Quantity

Serial Number


Order Information

CounterTrade Order Number (required)

Customer Purchase Order Number (required)


Return Information

Type of Return (required)

Condition of Product (required)

Reason for Return (required)

If other, please specify.

Additional Comments

You may upload any pictures of returns here.

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