Customer Name___________________________________________________

Address
___________________________________________________

___________________________________________________

RGA Number   ___________________________

Date of Purchase    ___/__/______ (must be within 30 days)

Daytime number ( ___  ) _____ -________

Email Address _____________________________

Year, Make, Model of Vehicle______________________________________

I understand the terms and conditions of returning or exchanging
product purchased from Rimz One

which are posted on the policy page under returns and exchanges.
__________________________________________

Signature Required

IMPORTANT:

Rimz One is not responsible for installation of product. Verification that all
merchandise has been received is the responsibility of the purchaser. Under
no circumstances is The Rimz One responsible for any labor or incidental charges,
including those related to warranty, defective, damaged, or incorrect merchandise.