Claim Form |
Date of Claim |
|
Receipt No# |
|
Date of Purchase |
|
Amount of Purchase |
|
Customer Name |
|
Customer Address |
|
|
|
Customer Email |
|
Customer Phone no. |
|
Place of Purchase |
Store Name: |
|
Online: |
Reason for Claim/Replacement |
|
Amount |
|
|
|
|
|
|
|
|
|
Total |
|
|