Return Goods Authorization 

RGA#: _____________________________________ 
Date: _________________

Customer Name: ____________________________

Address: __________________________________

___________________________________________

___________________________________________

City/State: _______________________________ 

Phone No: _________________________________

E-Mail Address: ___________________________


Reason for Return: 

___________________________________________

___________________________________________

___________________________________________

___________________________________________



Please print this form and be sure to include it

and a copy of your invoice with your return.

Thank You for Shopping at JBShardware.com.