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Product Return Notification Form

Dear Sir / Madam,

Thank you for notifying Therapak of your product return request. The purpose of this document submission form is for Therapak's customers to communicate preliminary information concerning a product return request so that appropriate follow up can be administered by our customer service, product management and quality assurance departments. If this is a basic request for return authorization, you will be contacted by our customer service department. If your submission concerns product quality, you will be contacted by a quality or product management representative in order to investigate the issue according to company procedures after the product is returned.

Please briefly describe the reason for the product return request in the area below.

Please describe any associated Lot Numbers, Part Numbers and Product Description for the product return in the area provided below.

We appreciate your assistance with this process. Please push the "Submit" button below and Therapak will respond to your request with guidance on the matter within one (1) business day.

Sincerely,
Therapak Corporation