Return Merchandise Request

Return Merchandise Request and Authorization Agreement

Request Number:   Date Submitted:

Whereas

WHEREAS, Requestor identified below purchased goods from Vendor identified below pursuant to the referenced order and now seeks authorization to return certain merchandise for refund, repair, replacement, or credit; and

WHEREAS, Vendor retains the right to inspect the merchandise, to determine whether the items qualify for return under Vendor's stated policies and this Agreement, and to authorize an appropriate remedy consistent with the Purchase Terms set forth herein; and

WHEREAS, the parties desire to document the return request, the scope of required remedial action, payment and refund terms, confidentiality of proprietary return information, and the governing law applicable to this authorization.

Requestor Information

Vendor Information

Order and Return Details

Items for Return (List each item)

Item 1

SKU:   Description:   Qty:

Unit Price:   Serial No.:   Condition:

Item 2

SKU:   Description:   Qty:

Unit Price:   Serial No.:   Condition:

(Add additional items by attaching supplemental pages bearing the Request Number.)

Scope of Work

Describe the requested disposition and remedial action to be performed by Vendor upon acceptance of returned merchandise. Include repair scope, replacement specifications, or refund calculation method.

Payment Terms

Refund Amount Requested:

Preferred Remedy (check applicable):
Refund to original payment method     Store credit     Replacement     Repair

Late Payment / Unfulfilled Refund: In the event Vendor does not issue the agreed refund or credit within the stated schedule, Vendor shall pay interest at the lesser of one percent (1%) per month or the maximum rate permitted by law, calculated from the scheduled refund date until payment in full.

Term and Termination

Effective Date:   Authorization Expires:

Notice Period for Termination:

Termination: Either party may terminate this authorization for cause upon written notice where the other party materially breaches the terms herein and fails to cure within the notice period. Vendor's acceptance of returned merchandise shall not waive Vendor's right to reject items that do not meet return criteria.

Confidentiality

All nonpublic information exchanged in connection with this return request, including return reasons, serial numbers, and inspection findings, shall be treated as Confidential Information. Neither party shall disclose such information to third parties except to its employees, agents, or contractors with a need to know, or as required by law. Confidential Information shall be used solely for the performance and resolution of this return authorization.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles. Venue for disputes shall be in the appropriate state or federal court located in that jurisdiction.

Entire Agreement

This document, together with any attachments or written authorizations expressly incorporated herein, constitutes the entire agreement between the parties concerning the return described and supersedes all prior oral or written representations and agreements. Any modification must be in writing and signed by both parties.

Authorization and Return Instructions

RMA Number (if assigned):   Return Shipping Instructions:

Inspection Acknowledgment: By submitting this Request, Requestor acknowledges that returned merchandise may be subject to inspection and testing by Vendor. If a returned item is determined not to qualify for return under Vendor policy or this Agreement, Vendor may assess a restocking fee or deny remedy as provided by law and these terms.

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