RGA Request Form

Account #			E-mail
Customer			Contact
Address			Ship to
PO #			Original Order #
Sidemark			Original Order Date
DSM

Product Type	Product
Lifting System	System
Reason	Choose One Broken Component Conversion Cut-Down Lengthen Mis-Ship Restring Shorten Stained/Flawed Fabric Warped Slats Wrong Fabric Wrong Size
Reason for Return	Repair       Credit/Remake
Remake #
Describe Reason:

Line Item No Qty Width Length Color # Color Name Lift Position Tilt Position ***** Left Right Center ***** Left Right Center

Repair at Authorized Service Center (ASC) Dealer
Preferred Authorized Service Center (ASC) Dealer Name:

Additional Comments:
* Please be advised that Hunter Douglas Customer Service will be contacting you shortly with your RGA number. Be sure that the units entered on this RGA are shipped with the appropriate RGA number marked on the outside of the box. Units that are received and do not match a RGA are subject to delays and/or will be returned.