Inkjet-Cartridges-Refills
Product Damaged/Lost in Transit Form

After printing and filling out this form, please fax (503-643-5379)
or mail it to us:    Inkjet-Cartridges-Refills
                                               10200 SW Eastridge Street, Suite #105
                    Portland, OR  97225

Office use only:

Date Received __________

Initials _______

It is the responsibility of the customer to ensure 
receipt of this form by our office.
A response will be emailed to you.

Please fill in all fields below as applicable.

ICR Order #: _________________________     Date of Order: _________________________
Product Was: (please check one)
[  ] Damaged [  ] Lost in Transit
 
Name (First and Last): Company:
Shipping Address on Order: City:
State/Province: Postal Code: Country:
Phone # (with country/area codes, if appl.): Fax #:
Email address:
 
 
Current Contact Information:
Name:
Phone#:
Email address:


 
Please list one item per line.
Line # ICR part # Qty Serial #
(if avail.)		 Date of
Purchase		 ICR Order/
Invoice #

Condition of Product
(choose one)
1          

 [  ] Damaged

 [  ] Undamaged

Describe Condition:

2          

 [  ] Damaged

 [  ] Undamaged

Describe Condition:

3          

 [  ] Damaged

 [  ] Undamaged

Describe Condition:

4          

 [  ] Damaged

 [  ] Undamaged

Describe Condition:


[  ] I would like to have the merchandise re-shipped immediately. If subsequent investigation yields a record that the product was delivered undamaged, I agree to pay all costs associated with the replacement of the merchandise and investigation.

[  ] I would like Inkjet-Cartridges-Refills to investigate my claim first and then replace the lost/damaged merchandise once the investigation has been completed.

I understand that this report will be processed according to the Terms and Condition of Sale at http://www.inkjet-cartridges-refills.com/terms.htm (link). I have read, understood, and agreed to be bound by these Terms and Condition of Sale and the Return Policy currently in effect at http://www.inkjet-cartridges-refills.com/returns.htm (link).

Your report 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 Inkjet-Cartridges-Refills.

Signed: ______________________________  Date: _______________________