Nokia Motrola

Item Return Authorization Form:

Please fill out the bellow form, once you done click on submit. and after confirmation you will receive the Return address and your Return Authorization Number and you can send the item Back.

Remember, fields marked with * are required.


*First name :		*Last name:

dddddddddddddddddddd

*Street address :

250 CHAR

Street 2 :

*City/Town :

*State :

*Zip/Postal code :

*Country :

*Phone :

(Note: You will only be called for order-related issues.)

*Product Name :

Max(49 CHR)

*Serial number or IMEI number:

*Date of purchase (MM/DD/YYYY):

*Seller user name:

*Buyer user name:

*eBay item number:

(Note: This Number will use in Tracking RMA.)

*Extended Warranty was purchased ?

Yes <% if Tom(16) = "V1" then CHECk1 = "checked" else if Tom(16) = "V2" then CHECk2 = "checked" end if %> > No>

*Your paypal e-mail :

<% if tom(17)="" then yuuu="yourname@email.com" else yuuu = tom(17) %>

*Re-enter paypal e-mail :

*Request:

<% CHECk1 ="" CHECk2 ="" select case Tom(19) case "V1" CHECk1 = "checked" case "V2" CHECk2 = "checked" case "V3" CHECk3 = "checked" case "V4" CHECk4 = "checked" end select %> >Credit/Refund >repair/replacement >exchange >Wrong shipment

*Problem description :
(450 CHR)

<% =tom(20) %>

Special note:
(350 CHR)

<% =tom(21) %>

*Type the 8 characters you see in the picture:

<% lo = 1 up =15 randomize timer fty=Int((up - lo + 1) * Rnd + lo) %>

*Policy and agreement:

I Agree.

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