Inkjet Cartridges Refills.com
RMA Request Form

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

Office use only:

Date Ordered/Shipped __________
Date RMA Req Received _________
Date RMA # Issued ____________
RMA # _____________ 
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: __________________________
RMA Type: (please check one)
[  ] Return for in-store credit [  ] Return for exchange [  ] Return for refund [  ] Return for repair/replacement [  ] Advanced replacement/return
 
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)

 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 an exchange*, please fill out the following, indicating the items desired:

ICR Part # Description Quantity Price per Item Total Cost
         
         
         
         
         
*Please note that applicable fees (restocking, etc.) will still apply in the case of an exchange.  Customer will pay the difference for any upgraded exchange orders.
Credit Card #: Exp.: ____ Mo ____ Yr CVV #*:
Billing Address: City:
State/Province: Postal Code: Country:
Phone # (with country/area codes, if appl.):

PO # (if appl.):

*The CVV # can be found on the back of your card, above the signature area.

                                  I am the authorized account holder of the credit card listed above. 

I understand that this RMA Request will be processed according to
the Terms and Condition of Sale at http://www.inkjet-cartridges-refills.com/terms.htm (link),
 including, but not limited to, any product return fees that may apply (see Point 4: "Product Returns").
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).

Signed: ______________________________  Date: _______________________