Customer Refund Acceptance Document

Customer Refund Acceptance Document
Customer Name_______________________________________________________________________

(Note: Please ensure that the customer name you are listing is the name for which you would like the refund check issued)

Address______________________________________________________________________________

(Note: Please ensure that the address you are listing is correct Mailing address for your refund check to be sent to)

Customer Signature ___________________________________________ Date____________________
Transaction Number: _______________________________________
Samsung is not responsible for refund checks delayed or lost in the mail if you enter the wrong information.
Before we can process your refund check or direct deposit, you must fax, email, or mail this letter back to us along with the following: (1) a clear image or photo of the removed serial number decals, and (2) a clear image or photo showing the cut power cord.
Fax Number: 973-529-0341

Email: [e-mail]

Address: Samsung Electronics America

Exchange and Refund Dept.

105 Challenger Road – 7^th Floor

Ridgefield Park, NJ 07660-0511
Important Notes Regarding Cut Power Cord
POWER CORD REQUIREMENT: You are required to provide proof of a cut power cord ONLY if your product is one of the following: a Microwave Oven, Refrigerator, Gas Dryer (120 VAC), Gas Oven (120 VAC) or Vacuum Cleaner. If your product is not listed above, a clear image or photo showing the cut power cord is NOT required.
POWER CORD SAFETY PRECAUTION: To avoid any risk of electric shock, Power Off your unit and Unplug your unit from electricity before cutting the power cord. Once these safety precautions have been completed, the power cord can be cut with either wire cutters or another instrument such as household scissors that will cut through the entire power cord with ease. For a complete list of safety precautions when handling your product, please refer to your product’s user/safety manual.

Please attach the removed serial decals and a clear image or photo showing the Cut Cord depending on product.