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Wholesale Enquiries
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Request For Refund Form

Name:_________________________________________

Address:_______________________________________

Phone:______________________Postcode:___________

Email address:___________________________________



State the item(s) you wish to return:

1_________________________________ Date of Purchase:_____________

2_________________________________ Date of Purchase:_____________

3_________________________________ Date of Purchase:_____________

4_________________________________ Date of Purchase:_____________

  (please tick) Yes, all the receipts for all the items above are included.



State the reason why you wish to return the above items:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Scan/email or Mail this Form To:

www.thehealthplace.com.au
720 North Road,
Ormond, Victoria, 3196,
AUSTRALIA

After reviewing this request for a refund, we will either:

  1. Agree that you receive a refund - Your money for the above goods will be
    refunded to you by the same method that you paid for these items, eg.
    If you paid by credit card, we will add credit to your credit card for the amount
    to be refunded.


  2. Disagree that you receive a refund - If your request does not meet our
    terms and conditions, no refund will be granted.

We will inform you if your request has been granted by email or phone.

Your Signature:___________________________

Your Name:______________________________

Date:_______________ (Date must be within 30 days of the "Date of Purchase" above)

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