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Epona Co. Claim Form

Claim Form

Please Print out the form below and fill in all necessary information. Photos and receipts should be attached to the form and emailed to admin@eponaco.com. PLEASE NOTE : Claims cannot be processed without attachments and photos*

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

PLEASE ATTACH COPY OF PHOTOS AND PROOF OF PURCHASE