Return Material Authorization (RMA) Form

This form can be used to submit a request for a Return Material Authorization (RMA) number, and applies to all Low Vision Store products.

RMA Process

An RMA number will be provided to you once the request is received and processed, and all information is provided to you once the request is received and processed, and all information is provided. Please make sure to enter an appropriate and accurate e-mail address in the e-mail address field below. All fields listed with an asterisk (*) are required.

Customer's Name:

Contact's Name, if different:

Customer's Telephone:

Contact's Telephone, if different:

Customer's Organization:

Customer's Email:

Street Address:

City:

State

Zip Code:

Product Type:

Serial Number:

Reason for Return:

Comments: