Return/Replacement Request

Customer Name / Contact Person(Required)

First Last

Company Name (if applicable)

Phone(Required)

Email(Required)

Invoice or Purchase Order Number(Required)

Order Date(Required)

DD slash MM slash YYYY

Item(Required)

Item Name

Serial Number (pump)

Quantity

Reason

No longer require due to

Damaged

Other

Please provide detail(Required)

Repalcement required?(Required)

No

Yes

Required By

DD slash MM slash YYYY

Please upload one or more photos. This proves item/s are in resaleable condition, or indicates any damage(Required)

Drop files here or

Max. file size: 128 MB, Max. files: 5.

Terms & Conditions(Required)

I declare the above information is true and correct, and accept Tsurumi Pump’s Terms & Conditions.

Email

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