INCLUDE THIS FORM WITH YOUR RETURN- Write Additional Notes On…

        INCLUDE THIS FORM WITH YOUR RETURN- Write Additional Notes On Back.
            Customer Name: ______________________________________________

           Customer Address: _____________________________________________

            Customer City: _____________ State: _______ Zip Code: _____________

                    Daytime Telephone Number: (____) ______ - ___________

                    Email Address: ____________________________________

          Item You Are Returning: ___________________________________________

    Reason for Return: [ ] Damaged In Shipping           [ ] Incorrect Item Received

                         [ ] Incorrect Item Ordered      [ ] Item was not what I expected

                                                      [ ] Item is Defective
Explain (Use back for additional notes): __________________________________________

______________________________________________________________________

______________________________________________________________________

             Please enclose a copy of your original order invoice if possible.

Shipping Instructions:
All returned items shipped to Circuit Specialists Inc. must be packaged properly. Please
double box all returns using an outer packing carton equal to or better than the outer shipping carton
it was shipped to you in. Failure to do so may result in damage to the item being returned including
the container the item is packaged in. Failure to ship in an outer shipping carton equal to or better
than the one used in the original shipment to you, may disqualify or reduce the amount refunded or
may disqualify an item for warranty service if it incurs shipping damage due to improper packaging.
Please do not damage, deface or add any markings to the original manufactures packaging. Failure to
comply may decrease your refund up to 20% to cover repackaging. We recommend using a shipping
method that requires a delivery signature.

                                         Action Requested:

[ ] Refund: Our policy allows end users 30 days to evaluate an item to determine suitability for
proposed use. All items must be returned within 30 days of purchase in original condition including
manufacturers packaging, manuals, instructions, etc to qualify for a refund. After the 30 day period,
items may be returned only for warranty repair or at the option of Circuit Specialists, Inc, replacement.
Please note the shipping conditions above.

[   ] Replace With Correct Merchandise: (please note the shipping instructions above.)

[ ] Warranty service: (please explain the problem above; also please note the shipping
instructions.)

                                        Ship Merchandise To:
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                                Circuit Specialists Inc.
                             220 S. Country Club Drive #2
                                    Mesa, AZ 85210