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Advanced Replacement Authorization Form
CSG Invoice/Sales Order Number:
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Email Address:
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Date of Request:
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Company Name:
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First Name:
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Last Name:
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Card Number:
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Security Code:
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Exp. Date:
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By electronically signing this form, I authorize Connected Solutions Group to charge the mentioned card above for the advance replacements if Connected Solutions Group does not receive my defective devices back within 14 working days using the provided UPS Return Label. Please keep a copy of this form for your records
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Clicking continue will take you to the processing payment page. You will receive a receipt via email when this payment has been processed. If you have any questions or problems submitting this form, please contact your sales representative.