RGA Request RGA REQUEST FORM Customer Name* Requested By* Delivery Date* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*PO Number* Order/Invoice Number Product must meet the following conditions if it is being returned as resale-able. If product does not meet these conditions, please comment below. Must be new and uninstalled. Must be in original packaging with no damage. Laser film must still be intact (if applicable Ex: Appliances / Outdoor). Item Number* Quantity* Serial Number Cause* Customer Cancellation Incorrect Item Ordered Incorrect Item Shipped Defective Claim (Comments Required) Action Codes* Credit to Account Credit to Credit Card Replace Product If replacement product is required, customer must submit a request with purchase order to firstname.lastname@example.orgPlease comment belowPictures Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 512 MB.