Your Name:       
E-Mail Address:  
Telephone Number:    Best Time (local):
Fax Number:       
Street Address:   
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Reason for request: Please check which applies with a R or X

 Fastener does not work in designated tool.
 Fastener is not of quality workmanship, material or coating.
 We shipped the wrong fastener.
 You ordered the wrong fastener for the application.
 You ordered the wrong fastener for the tool.
 You ordered too large of a quantity.

Invoice Number, Reference Number          
Date of Shipment                          

Request / Comments:





Please print out and fax information to: 603 382 1866