REFUND & ORDER CLAIM FORM
REFUND & ORDER CLAIM FORM
IMPORTANT CLAIM NOTICE
This Claim Form and all required supporting documentation must be submitted within 5 calendar days of carrier-confirmed delivery. Please email the completed form to Sales@SystemFourLLC.com
Submission of a claim does not guarantee a refund, replacement, credit, or other remedy. All claims are subject to review, verification, and investigation.
INVESTIGATION & VERIFICATION NOTICE
Claims involving a package reported as damaged, opened, missing, altered, or otherwise compromised may require an investigation with the shipping carrier.
As part of its investigation, System Four LLC may contact the shipping carrier and, when applicable, the delivery location or authorized pickup location to verify the circumstances surrounding the shipment, delivery, or pickup.
System Four LLC may request available records and evidence relevant to the claim, including contacting the carrier by phone or email, carrier tracking and scan records, delivery or pickup records, signatures, photographs, package-condition records, incident reports, and available video surveillance footage.
System Four LLC may also contact other relevant parties when reasonably necessary to investigate or verify information provided in connection with a claim.
The customer may be required to retain and make available the shipping container, packaging materials, merchandise, photographs, or other documentation reasonably necessary for System Four LLC or the shipping carrier to investigate the claim.
A claim determination may not be made until the applicable investigation and verification process has been completed.
CLAIM FORM
CUSTOMER INFORMATION
Customer Name: __________________________________________
Email Address: ___________________________________________
Phone Number: ___________________________________________
Order Number: ____________________________________________
Order Date: ______________________________________________
Shipping Carrier: _________________________________________
Tracking Number: _________________________________________
Carrier-Confirmed Delivery Date: ___________________________
TYPE OF CLAIM
Check all that apply:
☐ Package arrived damaged
☐ Package arrived opened
☐ Product damaged
☐ Incorrect product received
☐ Product(s) missing from shipment
☐ Other: _________________________________________________
CLAIM DETAILS
Product(s) involved:
___________________________________________________________________________
___________________________________________________________________________
Describe exactly what happened and the condition of the package and merchandise when received:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Date and time the issue was first discovered:
Date: _______________________ Time: _______________________
REQUIRED DOCUMENTATION
For damaged, opened, or otherwise compromised shipments, provide clear photographs showing, as applicable:
☐ Entire shipping package/box
☐ Shipping label and tracking number
☐ All sides of the shipping package
☐ Area(s) claimed to be damaged or opened
☐ Interior packaging
☐ All products received
☐ Any damaged product(s)
☐ Other evidence supporting the claim
The customer must retain the shipping box, packaging materials, and products until the claim review and investigation have been completed.
Do not discard or return products or packaging unless instructed in writing by System Four LLC.
CLAIMANT CERTIFICATION
I certify that the information and documentation submitted with this claim are true and accurate to the best of my knowledge.
I understand that System Four LLC may investigate and independently verify information concerning the order, shipment, delivery, pickup, package condition, merchandise, and claim with the shipping carrier, delivery or pickup location, payment provider, or other relevant parties.
I understand that submitting this Claim Form does not guarantee a refund, replacement, credit, or other remedy.
Claimant's Printed Name: __________________________________
Claimant's Signature: _____________________________________
Date: ____________________________________________________
ADDITIONAL VERIFICATION
System Four LLC reserves the right to request additional documentation or information when reasonably necessary to investigate or verify a claim.
For claims involving allegedly damaged, opened, missing, altered, or otherwise compromised merchandise or packaging, System Four LLC may require the claimant to provide a signed and notarized affidavit confirming the material facts of the claim.
Failure to provide reasonably requested documentation or verification may prevent System Four LLC