Product Warranty

Returned Goods Form
rev.072808
NITROUS EXPRESS, INC
5411 SEYMOUR HWY
WICHITA FALLS, TX 76310
Phone: [phone]
Fax: [phone]
Toll free [phone]
www.nitrousexpress.com
DATE ______________
Name ______________________________________________________________________
Shipping Address (no P.O. boxes) _______________________________ Apt / suite _______
City ________________________________________ State_____ Zip ____________
Telephone ____________ Cell ____________ E-Mail _______________________________
Items being returned
Part
Number
Description Quantity
Returned
Description of defect or damage
(Reason for return)
For quicker turn around, fill out the credit / debit card information below. NX will
automatically repair your items and return them to the shipping address listed above. If repairs
are not covered by the NX warranty, charges for repairs and return freight will be billed. If
repairs are covered by the NX warranty, only return freight charges will be billed. Please
include a copy of the original sales invoice for warranty consideration.
Credit / debit card type (circle one) Visa MasterCard Discover American Express
Credit Card Number ____________________________________ Expiration Date_________
3 or 4 digit Security code____ Name on card _______________________________________
Billing Address ______________________________________ Apt / suite _______________
City ________________________________________ State_____ Zip ____________
I authorize Nitrous Express to repair and /or replace the returned products as needed. I
furthermore authorize Nitrous Express to apply charges for parts, labor and freight as needed.
PRINTED NAME ____________________ FULL SIGNATURE ____________________