ASC Mouthpieces – RMA Request Form

Name *

First

Last

Email *

Please use the email address associated with your original purchase

Order Reference *

Date of Purchase *

Items to Return

How many items would you like to return? *

Item 1

Model Name & Size *

Reason For Return *

Item 2

Model Name & Size *

Reason For Return *

Item 3

Model Name & Size *

Reason For Return *

Item 4

Model Name & Size *

Reason For Return *

Item 5

Model Name & Size *

Reason For Return *

Refund Details

How would you like to receive your refund? *

Refund my original payment method
Store Credit

The return address will be provided once your return is pre-approved. Do not send your item before receiving a pre-approval email. We will issue your refund when we receive your return. We recommend that you use insured or tracked shipping.

I agree to return the item(s) cleaned, in its original condition and in the original packaging