Hearing Aid Return for Credit Form

Hearing Aid Return for Credit Form
Please complete this form to return your hearing aid and request store credit. All fields are required to process your return efficiently.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address (for return processing)
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Hearing Aid Model
Serial Number of Hearing Aid
Date of Purchase
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for Return
Describe the condition of the hearing aid upon return
Upload a photo of the hearing aid (optional, but helps with faster processing)
Cancelof
Have you included all accessories and original packaging?
Preferred resolution for your return
Signature (please sign to authorize your return)
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