RMA Refund Request

• Please print and fill out the following form to request an RMA number.

• All information must be completed in order to be approved.

• Upon completion, please fax to 1-309-757-1241.

• When your RMA form has been received, Mutual Wheel Company will send you an email confirmation of receipt.

• If you do not receive a confirmation that we received your fax or email, then please re-send your form or contact Mutual Wheel Company asap.

• Upon approval, an RMA number will be issued within 48hrs.

Attn: RMA Department
Fax Number: 1-309-757-1241

Customer Number:_____________________________Date:____________________________________

Original Invoice#______________________________Original Invoice Date:_______________________

Contact Name:__________________________________ E-MAIL:________________________________

 Part#: ________________ Product: ______________________________________

 Price: ________________ Reason: _______________________________________

 Part#: ________________ Product: ______________________________________

 Price: ________________ Reason: _______________________________________

 Part#: ________________ Product: ______________________________________

 Price: ________________ Reason: _______________________________________

 Part#: ________________ Product: ______________________________________

 Price: ________________ Reason: _______________________________________

I understand that Mutual Wheel Company will issue a refund for the return of invoice number #________________________ upon approval according to the 30 day money back guarantee policy. I understand that a 15% restocking fee is applicable to all refunds. The refund amount is subject to change, according to the conditions listed below.

 I understand that it is my responsibility to ship all merchandise in new condition and full insured to Mutual Wheel Company within 15 days of the issued refund number not to exceed 30 days from the original invoice date-whichever is sooner. Upon receipt of products, Mutual Wheel Company will inspect the merchandise for damage. All merchandise must be in original packaging and in new condition. New Condition constitutes: No permanent markings or missing components in original packaging. Missing or damaged products or accessories will be deducted from the refund amount and damaged products will be returned at the customer's expense. Items damaged in shipping will be deducted from the refund; however, Mutual Wheel Company will cooperate with the shipper to facilitate whatever insurance settlement may be due to the customer. Credit will be issued within 10 business days from the date of receipt.

Signature _______________________________