{{Form Assembly.Subheader Legal Text}}
{{Form Assembly.Company}}
{{Form Assembly.First Name}}
{{Form Assembly.Last Name}}
{{Form Assembly.Email}}
{{Form Assembly.Phone number}}
{{Form Assembly.Invoice Number}}
Nilfisk Item Number 1
Description 1
Claim Quantity 1
Claim Value 1
Nilfisk Item Number 2
Description 2
Claim Quantity 2
Claim Value 2
Nilfisk Item Number 3
Description 3
Claim Quantity 3
Claim Value 3
Total Claim Value (including GST)
Reason for Credit / Return
Damaged in Transit
Delivered Incorrect
Quantity
Incorrect Price Charged
Delivered Incorrect Item
Order No Longer Required
Item Faulty
Please provide further details for your claim
Please upload pictures of any damaged or incorrectly received stock
Accept return policy
Yes
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