Customer RMA Request Form Date * MM DD YYYY Order or PO Number * Customer Name (Company) * Address * This is the address where any replacements or exchanges will be shipped to. Address 1 Address 2 City State/Province Zip/Postal Code Country Requested By * First Name Last Name Email * Phone (###) ### #### Product * Serial Number * RF Electrodes Only Lot Number * Do you still have the factory packaging. * Yes No Return Type Requested * What type of return are you requesting. Refund/Store Credit Exchange for same product Exchange for different product. Warranty Exchange Reason For Return * Policy Confirmation * By checking this box and submitting, you confirm that you have reviewed all of the applicable policies (located below) pertaining to this return request. Agree Thank you for your submission. A representative will reach out about your request within 15 Business Days. POLICIES Reusable Return Policy Credit/ Refund Policy Disposable Return Policy Expired Product Return Policy Shipping and Handling Policy
