Refund Request

If you have received a Credit Memo indicating a credit to your account, please fill in the following information for your refund request.

Please do not use this form to return products!!! If you need to return products, please contact CUSTOMER SERVICE at 1-800-241-4623 or clicking HERE.

Required fields are indicated with an asterisk (*)

Account Number* :

First Name* :

Last Name* :

Company Name* :

Address* :

Department/Building/Suite :

City* :

State* :

ZIP/Postal Code* :

Daytime Phone* :

Fax Phone* :

Email Address* :

Refund Amount* :