Return Authority Request Form

Please fax this form to Alpine Customer Service on (03) 8787 1255 Or email to: claims@alpine.com.au (** = compulsory information)
Customer's Name: **Dealer Name/Code: Dealer Address: **Lodgement Date: **Phone: Fax: **Contact Person: **Model number: **Orig. i/v no: **Unit serial number:

Reason for request:

No longer required ("NLR") - incurs 15% + GST + freight restocking fee Alpine HO ordering error Alpine Sales team ordering error Returning item at the request of Alpine HO Failed upon install ("I.F" or "D.O.A") - needs immediate replacement (see section below)

tick to confirm:

Install Failure ("I.F.") returns:

This item stopped working to specifications during installation. I have performed tests on the item to confirm the nature of the failure. I have spoken to someone at Alpine HO about this issue. I have already swapped this item for the customer using shop stock. Charges may apply if the "I.F." unit is returned incomplete or unsaleable. **REASON FOR RETURNING GOODS:

<< -- RA Approval Details - Important information for the Dealer -- >>

Your I.F. replacement order number: Your 15% restocking fee invoice number:Your RA number:

TERMS AND CONDITIONS - RA valid 28 days from issue

1. In submitting this form you acknowledge your understanding and acceptance of the terms and conditions below. 2. Only items so identified by Alpine may be returned using Alpine's Startrack account via ECONOMY FREIGHT. 3. For booking call 132345 quoting account number 10070273 4. NLR items will receive a 15% + GST + freight restocking fee. 5. Alpine accepts no responsibility for loss or damage sustained during transit to or from Alpine Electronics Head Office. 6. Returned I.F. items are assessed upon receipt by Alpine. Non I.F. items will be treated as standard repairs and a charge may apply. 7. Returned items will only be accepted by Alpine if they are complete and in original box, clearly labelled with the RA number and packaged in appropriate protective shipping materials. Incomplete or damaged items will be returned to sender or may incur additional charges.