Eyewear Retail Refund Request Form
Please complete this form to request a refund for your eyewear purchase. All information provided will help us process your refund efficiently.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Order Number
*
Product Name or Model
*
Date of Purchase
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Refund
*
Received wrong item
Item damaged or defective
Not as described
Changed mind
Other
Please describe your refund request
*
Condition of Item
*
Unopened/Unused
Opened but unused
Used
Damaged
Preferred Refund Method
*
Original payment method
Store credit
Last 4 Digits of Payment Card (if applicable)
Submit Refund Request
Should be Empty: