rma_refund_request

RMA Refund Request Form

*Required

Coupon Code or Distributor ID Number Found on Warranty Card

This is a 4 or 5 digit number at the top of your warranty card inside your insole package or stamped or written on marketing material.

*Name

Business Name

*Phone Number

*Email

*Confirm Email

*Street Address

Street Address 2

*City

*State or Province

*Country

*Zip Code or Country Code

*Date of Purchase

*Place of Purchase

Please tell us where you purchased Foot Relief Insoles. Name of Fair, Trade Show, Retail Location, or Website.

*Total Purchase Price of All Merchandise You are Returning Including Tax

*How Did You Pay?

Last 4 Digits of Credit Card Used for Purchase - Skip if You Paid Cash

*Number of Pairs of Insoles You Are Returning

1 Pair constists of both a right and left insole.

*Number of Miracle Warmers You Are Returning

*Number of Aqua Balance Seat Cushions You Are Returning

Customer Comments

Terms and Conditions Required to Receive a Refund:

I understand and agree that I must fill out this RMA form and include a printed copy of this RMA form with my return (check your email once you hit submit). I also understand and agree that I must postmark my return on or before the 30th day from the date of purchase to receive a refund or to stop an automatic payment.

*Please Check the Box Below

I Have Read and Agree With the Terms and Conditions Required to Receive a Refund